Thyrotoxic vomiting: a case report and possible mechanisms

Abstract

The symptoms related to gastrointestinal (GI) tract are sometimes chief complaints in patients with endocrine disease. Thyrotoxicosis is a rare, but notable cause for unexplained and repeated vomiting. Here, we report an adolescent patient with thyrotoxicosis who was initially presented with repeated vomiting and epigastric pain. A 13-year-old female was referred to a GI outpatient department for evaluation of vomiting and abdominal pain from a pediatric clinic. Esophagogastroduodenoscopy revealed acute gastritis with duodenogastric reflux and suspicious reflux esophagitis of minimal change, but there was no significant improvement after treatment and as a result she was admitted to the emergency room. She was subsequently diagnosed as Graves' disease because an initial laboratory test at the GI outpatient department revealed thyroid stimulating hormone < 0.01 µIU/mL and additional blood tests showed elevated thyroid hormones and positive thyroid stimulating hormone receptor antibody. The vomiting and epigastric pain improved remarkably after treatment with antithyroid drugs. Clinicians should consider the possibility of thyrotoxicosis in patient with unexplained and repeated vomiting.

Keywords: Adolescent; Thyrotoxicosis; Vomiting.

Figure 1

Endoscopic findings show mild erythema with whitish turbidity around Z-line (A) and large amount of bile-mixed fluid in the gastric lumen with bile stainings on the gastric mucosa (B). After suctioning of all fluid and washing the gastric mucosa with water, multiple linear mild erythematous changes on gastric mucosa are observed (C, D).

Figure 2

Ultrasonography of the thyroid glands. Both lobes in the transverse plane reveal diffusely enlarged round lobes and decreased parenchymal echogenecity (A). Doppler examination for right lobe (B) and left lobe (C) demonstrates increased vascularity.