Ann Clin Diabetes Endocrinol | Volume 1, Issue 1 | Case Study | Open Access
Salem Bouomrani1,2*, Nesrine Regaïeg1, Marwa Nefoussi1 and Hanène Nouma1
1Department of Internal Medicine, Military Hospital of Gabes, Tunisia
2University of Sfax, Tunisia
*Correspondance to: Salem Bouomrani
Fulltext PDFIntroduction: Abdominal symptoms are exceptional and often labeled unusual during thyrotoxicosis. It can be abdominal pain, vomiting or nausea and sometimes even true acute pseudo-surgical abdomen presenting a real diagnostic challenge. Case
Presentation: A 21-year-old woman, with no pathological medical history, was hospitalized in our department because of acute and febrile abdominal pain initially causing suspicion of acute appendicitis. A surgical emergency was ruled out by the surgeons in the emergency room based on clinical, biological, and ultrasound exams. The somatic examination found a febrile patient at 39.5°C and a slightly sensitive abdomen in its entirety without palpable masses or organomegalies. The standard x-ray and abdominal ultrasound showed no abnormalities. The basic biological tests were within normal limits. A genital or digestive infection was also eliminated. Digestive fibroscopy was normal and the immunological balance was negative. Hormonal tests revealed primary hyperthyroidism with TSH at 0.04 μUI/ml (0.25 to 5) and FT4 at 34.4 pmol/l. Specific etiological investigations of this hyperthyroidism resulted in Graves' disease. Treated with Thiamazole at a dose of 30 mg/day with a beta-blocker, the course was rapidly favorable with a pyrexia and disappearance of abdominal pain. No recurrence has been noted for 3 years now.
Conclusion: As exceptional as it is, this presentation of hyperthyroidism deserves to be known by clinicians to avoid unnecessary and sometimes heavy surgery. Some authors recommend a thyroid screening for any abdominal pain that is not proven, particularly in women and outside pathological gastrointestinal history.
Acute abdomen; Hyperthyroidism; Graves’ disease; Thyrotoxic storm
Bouomrani S, Regaïeg N, Nefoussi M, Nouma H. False Acute Abdomen: Unusual Circumstance Revealing Hyperthyroidism. Ann Clin Diabetes Endocrinol. 2018; 1(1): 1006.