Thyroid storm is a rare but potentially life-threatening complication of excessive
thyroid hormone action. It is associated with a hypercoagulable state and reported to increase the risk of
thromboembolism. However, the role of anticoagulation in
thyroid storm still remains controversial and inconclusive. A 22-year-old male with no significant past medical history presented with acute severe generalised
abdominal pain. He was found to be profoundly thyrotoxic on arrival at our institution and subsequently diagnosed with
thyroid storm secondary to newly diagnosed
Graves' disease. Extensive
thromboses of the splanchnic, iliac, femoral veins and pulmonary arteries were subsequently demonstrated on CT scan. He had prolonged bowel
ileus as a sequela of mesenteric ischaemia requiring
total parenteral nutrition and non-oral forms of anti-thyroid drugs for management of
hyperthyroidism. He was in sinus rhythm throughout his inpatient stay, and there was no personal history of prothrombotic conditions. His
thrombophilia screen was normal. He eventually required jejunectomy due to jejunal ischaemia from extensive involvement of portal and mesenteric veins. He underwent radioiodine ablation for definitive treatment. He is currently hypothyroid and receiving
thyroxine replacement. Thyroid storms are hypercoagulable states and can be associated with extensive
thromboembolism even in the absence of
atrial fibrillation. To our knowledge, this is the first report of severe extensive
thromboembolism complicated by severe mesenteric ischaemia and bowel
ileus in the setting of a
thyroid storm. Routine prophylactic anticoagulation should be considered in those presenting with thyroid storms.
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