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Getting around the gut: a unique management challenge of thyroid storm precipitated by amphetamine-associated duodenal ischaemia leading to compromised enteric absorption
  1. Jin Sol Gene Lee1,
  2. Ian Elliott Brown2,
  3. Alison M Semrad3,4 and
  4. Amir A Zeki5
  1. 1Internal Medicine, University of California Davis, Sacramento, California, USA
  2. 2Surgery, University of California Davis, Sacramento, California, USA
  3. 3Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of California Davis, Sacramento, California, USA
  4. 4Endocrinology, Tahoe Forest Health System, Tahoe, California, USA
  5. 5Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California Davis, Sacramento, California, USA
  1. Correspondence to Dr Jin Sol Gene Lee; jinsol.meded{at}; Dr Amir A Zeki; aazeki{at}


Thyroid storm is a rare, life-threatening endocrine emergency with a high mortality rate of up to 30%. We present a unique management challenge of a critically ill patient who developed thyroid storm in the setting of a duodenal perforation from amphetamine-associated non-occlusive mesenteric ischaemia. The diagnosis of ‘thyroid storm’ was made based on clinical criteria and a Burch-Wartofsky score of 100. During emergent exploratory laparotomy, a 1 cm duodenal perforation with surrounding friable tissue was found and repaired. Intraoperatively, a nasogastric tube was guided distal to the area of perforation to allow for enteric administration of medications, which was critical in the setting of thyroid storm. Therapeutic plasma exchange achieved biochemical control of our patient’s thyroid storm but ultimately did not prevent in-hospital mortality.

  • thyrotoxicosis
  • general surgery
  • adult intensive care
  • hyperthyroidism
  • thyroid disease

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  • Contributors JSGL was the medical intern involved in the patient’s care and was responsible for collecting and analysing the patient data, curating the table and figures, searching relevant existing literature on the management of thyroid storm including guidelines and case reports, and was the first author of the case report primarily responsible for the writing the manuscript of the case report. AAZ was senior attending for the patient’s care and was the senior author for the case report who was the final reviewer of the case report assisting with editing the manuscript and providing relevant recommendations on discussion points within the manuscript. IEB provided information on the patient’s surgical management as the primary surgeon involved in the case and assisted with reviewing and editing the manuscript. AMS was the primary endocrinologist involved in the patient’s care and provided recommendations on relevant guideline-based care of thyroid storm and assisted in reviewing and editing the manuscript as well.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.