DUODENAL OBSTRUCTION IN THYROID STORM

A 35-year-old, previously healthy woman, known to be thyrotoxic, was t ransferred from a community hospital for ''acute abdomen.'' Abdominal pain, distention, and hyperemesis resolved with placement of nasogastr ic tube (NGT) and return of 2,600 mt of bilious fluid. Continued high NGT output made oral or NGT administration of antithyroid drugs imposs ible. We gave propylthiouracil (PTU) by retention enemas with therapeu tic serum levels and sublingual saturated solution of potassium iodide (SSKI) with 70% absorption based on 24-hour free iodine urinary excre tion. The patient's thyroxine (T-4) and triiodothyronine (T-3) radioim munoassays were normal on hospital days 10 and 12, respectively. Howev er, free T-4 and T-3 resin uptake did not normalize until hospital day 31. On hospital day 32, she tolerated removal of NGT without nausea a nd 4 days later was taking a regular diet. We conclude that our patien t's gastrointestinal symptoms were a prominent feature of her thyrotox icosis and that rectal PTU and sublingual SSKI are effective in admini stration of antithyroid drug.