{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T03:36:00Z","timestamp":1789097760702,"version":"build-2803163510"},"reference-count":51,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2011,3,1]],"date-time":"2011-03-01T00:00:00Z","timestamp":1298937600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2011,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The management of patients with severe thyrotoxicosis in the absence of a functional gastrointestinal tract represents an uncommon but significant clinical challenge associated with a high mortality rate. This article offers a literature review and discussion of the available management options in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary:<\/jats:title>\n                    <jats:p>Treatment of severe thyrotoxicosis in patients unable to ingest medications by the oral route should focus on normalization of thyroid hormone levels utilizing conventional medical therapy for thyrotoxicosis, administered via non-oral routes. This includes thionamides, beta-blockers, iodine containing solutions, and glucocorticoids. When conventional medical therapy fails, plasmapheresis should be considered as a temporary therapeutic bridge until conventional therapies can be instituted effectively or emergent surgery performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Although a rare scenario, the management of patients with severe thyrotoxicosis in the absence of a functional gastrointestinal tract represents a challenging clinical situation. Endocrinologists and critical care physicians should be apprised of the available treatment modalities which must be instituted swiftly in order to avoid a catastrophic outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/thy.2010.0159","type":"journal-article","created":{"date-parts":[[2011,1,22]],"date-time":"2011-01-22T12:31:02Z","timestamp":1295699462000},"page":"215-220","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":28,"title":["Management of Severe Thyrotoxicosis When the Gastrointestinal Tract Is Compromised"],"prefix":"10.1177","volume":"21","author":[{"given":"Eman","family":"Alfadhli","sequence":"first","affiliation":[{"name":"Taibah University","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G.","family":"Gianoukakis","sequence":"additional","affiliation":[{"name":"Harbor-UCLA Medical Center"},{"name":"David Geffen School of Medicine at UCLA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,3,1]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(90)90130-6"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.4158\/EP.12.1.43"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2008.03.005"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-199711000-00018"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.1995.5.403"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcn111"},{"key":"e_1_3_2_8_2","first-page":"382","article-title":"Vomiting, nausea, and abdominal pain: unrecognized symptoms of thyrotoxicosis","volume":"29","author":"Harper MB","year":"1989","unstructured":"Harper MB. 1989. Vomiting, nausea, and abdominal pain: unrecognized symptoms of thyrotoxicosis. J Fam Pract, 29:382\u2013386.","journal-title":"J Fam Pract"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.6029.209"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.57.668.405"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-198410000-00008"},{"key":"e_1_3_2_12_2","first-page":"311","article-title":"Severely sustained vomiting as the main symptom in a man with thyrotoxicosis","volume":"66","author":"Chen P","year":"2003","unstructured":"Chen P, , Chen HF, , Tan SW, , Su MC, , Ng KW, , Jiang CF. 2003. Severely sustained vomiting as the main symptom in a man with thyrotoxicosis. J Chin Med Assoc, 66:311\u2013314.","journal-title":"J Chin Med Assoc"},{"key":"e_1_3_2_13_2","first-page":"293","article-title":"Hyperthyroidism as a cause of persistent vomiting","volume":"62","author":"Hoogendoorn EH","year":"2004","unstructured":"Hoogendoorn EH, , Cools BM. 2004. Hyperthyroidism as a cause of persistent vomiting. Neth J Med, 62:293\u2013296.","journal-title":"Neth J Med"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.15.2834"},{"key":"e_1_3_2_15_2","first-page":"745","article-title":"Effect of hyperthyroidism on the transit of a caloric solid-liquid meal through the stomach, the small intestine, and the colon in man","volume":"75","author":"Wegener M","year":"1992","unstructured":"Wegener M, , Wedmann B, , Langhoff T, , Schaffstein J, , Adamek R. 1992. Effect of hyperthyroidism on the transit of a caloric solid-liquid meal through the stomach, the small intestine, and the colon in man. J Clin Endocrinol Metab, 75:745\u2013749.","journal-title":"J Clin Endocrinol Metab"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-78-5-669"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1677\/joe.0.1510431"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2006.09.008"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-54-1-180"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1089\/105072502320288500"},{"key":"e_1_3_2_21_2","first-page":"285","article-title":"Rectal absorption of propylthiouracil","volume":"26","author":"Bartle WR","year":"1988","unstructured":"Bartle WR, , Walker SE, , Silverberg JD. 1988. Rectal absorption of propylthiouracil. Int J Clin Pharmacol Ther Toxicol, 26:285\u2013287.","journal-title":"Int J Clin Pharmacol Ther Toxicol"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01485218"},{"key":"e_1_3_2_23_2","first-page":"67","article-title":"Effectiveness of intravenous administration of methimazole in patients with thyroid crisis","volume":"39","author":"Sowinski J","year":"1988","unstructured":"Sowinski J, , Junik R, , Gembicki M. 1988. Effectiveness of intravenous administration of methimazole in patients with thyroid crisis. Endokrynol Pol, 39:67\u201373.","journal-title":"Endokrynol Pol"},{"key":"e_1_3_2_24_2","first-page":"464","volume-title":"Intravenous administration of propylthiouracil in treatment of a patient with Graves' disease 77th Annual Meeting, The Endocrine Society","volume":"3","author":"Gregoire G","year":"1995","unstructured":"Gregoire G, , Aris-Jilwan N, , Ninet B. 1995 Intravenous administration of propylthiouracil in treatment of a patient with Graves' disease 77th Annual Meeting, The Endocrine Society. P3:464(abstract)."},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2006.16.691"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.12968\/hmed.2006.67.Sup9.22004"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2005.15.746"},{"key":"e_1_3_2_28_2","first-page":"131","article-title":"Clinical efficacy and safety of transdermal methimazole in the treatment of feline hyperthyroidism","volume":"47","author":"Lecuyer M","year":"2006","unstructured":"Lecuyer M, , Prini S, , Dunn ME, , Doucet MY. 2006. Clinical efficacy and safety of transdermal methimazole in the treatment of feline hyperthyroidism. Can Vet J, 47:131\u2013135.","journal-title":"Can Vet J"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1159\/000088509"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1159\/000148222"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2005.03.002"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-6757(91)90083-V"},{"key":"e_1_3_2_33_2","first-page":"1143","article-title":"Perioperative and postoperative management of two patients with uncontrolled hyperthyroidism using short acting beta blocker, landiolol","volume":"57","author":"Fujita Y","year":"2008","unstructured":"Fujita Y, , Shimizu T, , Matsumoto A, , Aoki M. 2008. Perioperative and postoperative management of two patients with uncontrolled hyperthyroidism using short acting beta blocker, landiolol. Masui, 57:1143\u20131146.","journal-title":"Masui"},{"key":"e_1_3_2_34_2","first-page":"652","volume-title":"The Thyroid","author":"Wartofsky L","year":"2005","unstructured":"Wartofsky L. 2005. Thyrotoxic storm. Braverman LE, , Utiger RD. The Thyroid, 9th. Lipincott, Williams & Wilkins: Philadelphia, 652.","edition":"9"},{"key":"e_1_3_2_35_2","first-page":"75","volume-title":"Current Therapy in Endocrinology and Metabolism","author":"Benua RS","year":"1994","unstructured":"Benua RS, , Becker DV, , Hurley JR. 1994. Thyroid storm. Bardin CW. Current Therapy in Endocrinology and Metabolism, 5th. Mosby: St Louis, 75.","edition":"5"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1969.00300220036006"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8529(18)30165-8"},{"key":"e_1_3_2_38_2","first-page":"1","article-title":"Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole-induced agranulocytosis","volume":"3","author":"Vyas A","year":"2010","unstructured":"Vyas A, , Vyas P, , Fillipon NL, , Vijayakrishnan R, , Trivedi N. 2010. Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole-induced agranulocytosis. Endocr Pract, 3:1\u201312.","journal-title":"Endocr Pract"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1368-5031.2004.00140.x"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20200"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20240"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine1962.25.246"},{"key":"e_1_3_2_43_2","first-page":"774","volume-title":"Goldfrank's Toxicologic Emergencies","author":"Bouchard NC","year":"2006","unstructured":"Bouchard NC. 2006. Thyroid and antithyroid medications. Flomenbaum NE, , Goldfrank LR, , Hoffman RS, , Howland MA, , Lewin NA, , Nelson LS. Goldfrank's Toxicologic Emergencies, 8th edition. McGraw-Hill: New York, 774.","edition":"8"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20161"},{"key":"e_1_3_2_45_2","first-page":"713","article-title":"Post-operative thyroid storm treated by plasmapheresis","volume":"38","author":"Martin C","year":"1981","unstructured":"Martin C, , Auffray JP, , Rocca B, , Dumas D, , Gouin F. 1981. Post-operative thyroid storm treated by plasmapheresis. Anesth Analg, 38:713\u2013715.","journal-title":"Anesth Analg"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(03)01246-3"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2004.04154.x"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8529(03)00010-0"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1089\/105072503322511337"},{"key":"e_1_3_2_50_2","first-page":"52","article-title":"Thyroidectomy as the last chance treatment for life threatening thyrotoxicosis. Case report","volume":"58","author":"Gietka-Czernel M","year":"2007","unstructured":"Gietka-Czernel M, , Jastrzebska H, , Dudek A, , Szczepkowski M, , Zgliczy\u0144ski W. 2007. Thyroidectomy as the last chance treatment for life threatening thyrotoxicosis. Case report. Endokrynol Pol, 58:52\u201356.","journal-title":"Endokrynol Pol"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1212140"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2004.00554.x"}],"container-title":["Thyroid\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/thy.2010.0159","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/thy.2010.0159","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/thy.2010.0159","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T05:45:45Z","timestamp":1777700745000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/thy.2010.0159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,3]]},"references-count":51,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2011,3]]}},"alternative-id":["10.1089\/thy.2010.0159"],"URL":"https:\/\/doi.org\/10.1089\/thy.2010.0159","relation":{},"ISSN":["1050-7256","1557-9077"],"issn-type":[{"value":"1050-7256","type":"print"},{"value":"1557-9077","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,3]]}}}