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.