A Case of Thyroid Crisis due to a Perforated Duodenal Ulcer

Norihito Ise and Kimiyuki Shirayama

Department of Surgery, Fujiwara Memorial Hospital

A 53-year-old woman with an unremarkable physical history and reporting sudden abdominal pain was diagnosed with panperitonitis due to a perforated duodenal ulcer. She underwent emergency laparotomy involving closure of the perforated duodenal ulcer with an omental patch, peritoneal lavage, and drainage. Before and during surgery, hypertension and tachycardia continued and diffuse swelling of the thyroid gland was pointed out on postoperative palpation of the neck. Symptoms and signs suggested thyroid crisis, so immediate treatment was started by intravenous injection of thiamazole 90 mg/day and iopamidol 1 ml/day, and continuous intravenous injection of diltiazem hydorochloride even before being shown blood levels of thyroid hormones. Later, a diagnosis of hyperthyroidism was established by laboratory data. The patient progressed favorably without signs of heart failure or delirium. The antithyroid drug was changed to injection for an internal medicine and a diet started. After blood thyroid hormones normalized, she was discharged on postoperative day 15. Thyroid crisis, which is life-threatening, is induced by surgery so a point that all surgeons should be aware of.

Key words
thyroid crisis, perforated duodenal ulcer

Reprint requests
Norihito Ise Department of Surgery, Fujiwara Memorial Hospital
47 Tenno-aza-Kamiegawa, Katagami, 010-0201 JAPAN

Accepted
April 27, 2005

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