Eschlböck Sophie, Lalos Alexandros, Poljo Adisa, Kern Beatrice, Posabella Alberto, Taha-Mehlitz Stephanie
Clarunis - University Digestive Health Care Center, St. Clara Hospital and University Hospital of Basel, Basel, Switzerland.
Faculty of Medicine, University of Basel, Basel, Switzerland.
AACE Endocrinol Diabetes. 2025 May 8;12(2):117-120. doi: 10.1016/j.aed.2025.04.010. eCollection 2025 Jul-Aug.
Acute abdomen often requires urgent surgical intervention. In certain instances, thyrotoxicosis can contribute to the onset of acute abdomen. This relationship complicates both diagnosis and management. Therefore, understanding the interplay between thyrotoxicosis and acute abdomen is essential for implementing effective treatment strategies. This case report aims to illustrate the diagnostic and therapeutic challenges encountered in managing a patient with mesenteric ischemia due to thyroid storm, emphasizing the importance of a multidisciplinary approach in achieving favorable outcomes.
We describe a case of a 54-year-old female who presented with acute abdominal pain, rapidly deteriorating to respiratory failure requiring intubation. Initial investigations revealed an embolic occlusion of the superior mesenteric artery and signs of bowel ischemia as well as cardiopulmonary decompensation. To evaluate the cause of the cardiac failure, subsequent thyroid function tests confirmed hyperthyroidism. The patient underwent endovascular embolectomy, bowel resection, and later a total thyroidectomy.
The patient's acute abdomen was managed with embolectomy and bowel resection. A Burch-Wartofsky score of 75 was highly suggestive of thyroid storm, leading to an urgent total thyroidectomy after interdisciplinary discussion. Histopathological examination confirmed chronic thyroid inflammation with increased endocrine activity.
This case highlights the serious complication of mesenteric ischemia due to thyroid storm. Endovascular thrombectomy and bowel resection effectively managed the ischemia, while thyroidectomy facilitated a rapid return to a euthyroid state. This case serves as a valuable reference for the management of similar presentations, demonstrating the potential for successful outcomes with timely, aggressive treatment.
急腹症通常需要紧急手术干预。在某些情况下，甲状腺毒症可导致急腹症的发生。这种关系使诊断和治疗都变得复杂。因此，了解甲状腺毒症与急腹症之间的相互作用对于实施有效的治疗策略至关重要。本病例报告旨在说明在治疗一名因甲状腺风暴导致肠系膜缺血的患者时遇到的诊断和治疗挑战，强调多学科方法对于取得良好结果的重要性。
我们描述了一名54岁女性的病例，她出现急性腹痛，迅速恶化为呼吸衰竭需要插管。初步检查发现肠系膜上动脉栓塞性闭塞以及肠缺血和心肺失代偿的迹象。为评估心力衰竭的原因，随后的甲状腺功能检查证实为甲状腺功能亢进。患者接受了血管内取栓术、肠切除术，随后进行了甲状腺全切除术。
患者的急腹症通过取栓术和肠切除术进行治疗。Burch-Wartofsky评分为75高度提示甲状腺风暴，经多学科讨论后紧急进行了甲状腺全切除术。组织病理学检查证实为慢性甲状腺炎症伴内分泌活性增加。
本病例突出了甲状腺风暴导致肠系膜缺血的严重并发症。血管内血栓切除术和肠切除术有效治疗了缺血，而甲状腺切除术促进了迅速恢复到甲状腺功能正常状态。本病例为类似病例的治疗提供了有价值的参考资料，表明及时、积极治疗有可能取得成功结果。
