A Case of Thyroid Crisis due to a Perforated Duodenal Ulcer

Abstract

A 30-year-old woman visited our ER complaining of general edema and acute epigastric pain. She was diagnosed as having diffuse peritonitis due to upper intestinal perforation, with congestive heart failure. Emergency laparotomy revealed a perforated duodenal ulcer, and peritoneal lavage with omental prombage was performed. Postoperatively, she developed severe tachycardia and hypertension. Blood examination revealed elevation of the WBC count, with elevated serum CRP and total bilirubin levels, and markedly reduced thyroid stimulating hormone levels. Based on these findings, she was suspected as having thyrotoxic crisis, and potassium iodide was administered via a nasogastric tube. As hemodynamic stability failed to be achieved despite intensive treatment at our hospital, the patient was transferred to a university hospital for further treatment. She was diagnosed as having thyrotoxic crisis accompanied by Basedow disease, and was provided intensive care for cardiovascular and respiratory failure. She was then transferred back to our hospital 18 days later, and then to a subsequent institution for rehabilitation 48 days after the primary operation. Thyrotoxic crisis can become fatal, unless proper and quick treatment is provided. Herein, we report a rare case of thyrotoxic crisis complicating untreated hyperthyroidism, associated with a perforated duodenal ulcer.