{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:35:02Z","timestamp":1787016902088,"version":"build-2736575974"},"reference-count":18,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,10,29]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:p>Thyroid storm is a rare, fatal complication of thyrotoxicosis that necessitates aggressive medical treatment. We present a case of a patient who developed duodenal ulcer perforation as a result of a thyroid storm caused by Graves\u2019 thyrotoxicosis. In addition to life-threatening intra-abdominal sepsis complicated by high anion-gap metabolic acidosis, he was found to have severely deranged thyroid hormone levels and clinical features compatible with thyroid storm based on the Burch-Wartofsky Score. Diagnosis and management of such patients with compromised gastrointestinal (GI) tract present a remarkable clinical challenge to the anaesthetist and the intensivists. Multidisciplinary care with rapid preoperative optimisation, careful intraoperative anaesthetic techniques and postoperative care resulted in excellent outcomes. This case report sheds light on how to tailor general anaesthesia to minimise physiological derangement associated with thyroid storm and re-establish homeostasis in patients presenting for emergent surgery, particularly those with GI dysfunction.<\/jats:p>","DOI":"10.1136\/bcr-2022-250816","type":"journal-article","created":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T09:45:38Z","timestamp":1672393538000},"page":"e250816","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Anaesthesiology perspective on a multidisciplinary approach to optimal perioperative management of a patient with giant peptic ulcer perforation caused by the physiological stress of a thyroid storm necessitating emergent laparotomy"],"prefix":"10.1136","volume":"15","author":[{"given":"Sujani","family":"Wijeratne","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, Intensive Care and Pain Medicine, Khoo Teck Puat Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Intensive Care and Pain Medicine, Khoo Teck Puat Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinoo Suran","family":"Kirthinanda","sequence":"additional","affiliation":[{"name":"Jurong Health Campus, Anaesthesiology, National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,30]]},"reference":[{"key":"2025082800251178000_15.12.e250816.1","unstructured":"Wall RT . Thyroid Disease. In: Anaesthesia and co-existing disease. 7 edn. Edinburgh: Churchill Livingstone, 2018: 449\u201375."},{"key":"2025082800251178000_15.12.e250816.2","doi-asserted-by":"publisher","DOI":"10.1177\/0885066613498053"},{"key":"2025082800251178000_15.12.e250816.3","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1089\/thy.2018.0275","article-title":"National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004-2013","volume":"29","author":"Galindo","year":"2019","journal-title":"Thyroid"},{"key":"2025082800251178000_15.12.e250816.4","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.bja.2021.06.043","article-title":"Risk of perioperative thyroid storm in hyperthyroid patients: a systematic review","volume":"127","author":"de Mul","year":"2021","journal-title":"Br J Anaesth"},{"key":"2025082800251178000_15.12.e250816.5","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.115"},{"key":"2025082800251178000_15.12.e250816.6","unstructured":"Pokhrel B , Aiman W , Bhusal K . Thyroid Storm. Treasure Island (FL): StatPearls Publishing, 2022. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448095"},{"key":"2025082800251178000_15.12.e250816.7","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2020-238889","article-title":"Getting around the gut: a unique management challenge of thyroid storm precipitated by amphetamine-associated duodenal ischaemia leading to compromised enteric absorption","volume":"14","author":"JSG","year":"2021","journal-title":"BMJ Case Reports CP"},{"key":"2025082800251178000_15.12.e250816.8","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0889-8529(18)30165-8","article-title":"Life-Threatening thyrotoxicosis. thyroid storm","volume":"22","author":"Burch","year":"1993","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2025082800251178000_15.12.e250816.9","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1507\/endocrj.EJ16-0336","article-title":"2016 guidelines for the management of thyroid storm from the Japan thyroid association and Japan endocrine Society (first edition)","volume":"63","author":"Satoh","year":"2016","journal-title":"Endocr J"},{"key":"2025082800251178000_15.12.e250816.10","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2011.0334"},{"key":"2025082800251178000_15.12.e250816.11","doi-asserted-by":"crossref","first-page":"bvab040","DOI":"10.1210\/jendso\/bvab040","article-title":"Cardiovascular events in patients with thyroid storm","volume":"5","author":"Waqar","year":"2021","journal-title":"J Endocr Soc"},{"key":"2025082800251178000_15.12.e250816.12","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1111\/cen.12949","article-title":"Treatment and management of thyroid storm: analysis of the nationwide surveys: the Taskforce Committee of the Japan thyroid association and Japan endocrine Society for the establishment of diagnostic criteria and nationwide surveys for thyroid storm","volume":"84","author":"Isozaki","year":"2016","journal-title":"Clin Endocrinol"},{"key":"2025082800251178000_15.12.e250816.13","first-page":"232470961774790","article-title":"Propranolol-Induced circulatory collapse in a patient with thyroid crisis and underlying Thyrocardiac disease: a word of caution","volume":"5","author":"Abubakar","year":"2017","journal-title":"J Investig Med High Impact Case Rep"},{"key":"2025082800251178000_15.12.e250816.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2006.01.009"},{"key":"2025082800251178000_15.12.e250816.15","doi-asserted-by":"publisher","DOI":"10.1210\/endo-45-5-504"},{"key":"2025082800251178000_15.12.e250816.16","doi-asserted-by":"publisher","DOI":"10.1210\/endo-120-3-1033"},{"key":"2025082800251178000_15.12.e250816.17","doi-asserted-by":"crossref","first-page":"477","DOI":"10.4097\/kjae.2012.63.5.477","article-title":"Thyroid storm during induction of anesthesia","volume":"63","author":"Park","year":"2012","journal-title":"Korean J Anesthesiol"},{"key":"2025082800251178000_15.12.e250816.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-9987.2011.01003.x"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-250816","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:25:21Z","timestamp":1756365921000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-250816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":18,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,30]]},"published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1136\/bcr-2022-250816"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-250816","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12]]}}}