Maung and co-authors present the case of an acutely unwell 22-year-old man. The primary presenting feature was severe abdominal pain, and the patient was haemodynamically unstable on admission, with a regular tachycardia, hypotension, fever and tachypnoea. He had central abdominal tenderness and guarding. Blood tests indicated acute kidney injury, and lactate was grossly elevated. Subsequent imaging showed evidence of mesenteric ischaemia, secondary to diffuse intra-abdominal venous thrombosis. Pulmonary embolus was also detected.

The underlying diagnosis was determined by the clinical signs of a goitre and dysthyroid eye disease, plus elevated free thyroid hormones and suppressed thyrotrophin. The Burch−Wartofsky score was calculated as 60. The authors describe in detail the challenges of managing this man’s thyroid storm, complicated by prolonged bowel ileus necessitating parenteral nutrition and therapeutics. Episodes of melaena made anticoagulation decisions difficult. Tests for genetic and acquired thrombophilias were negative.

The case serves as a valuable reminder of the hypercoagulable state that can result from thyrotoxicosis, and the authors discuss the role of prophylactic anticoagulation in thyroid storm patients, even those without tachyarrhythmia.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports doi:10.1530/EDM-20-0118