Managing concurrent thyrotoxicosis and acute appendicitis: a case report and perioperative considerations

Abstract

Thyrotoxicosis can mimic acute abdominal pathology and may progress to thyroid storm when combined with surgical sepsis. A 47-year-old woman with poorly controlled Graves’ disease presented with right iliac fossa pain, fever, tachycardia and biochemical thyrotoxicosis. Her Burch-Wartofsky score was 60, indicating high storm risk. Ultrasound and CT confirmed tip appendicitis. She was admitted to intensive care and treated with beta-blockade, high-dose thionamides, Lugol’s iodine, corticosteroids and antibiotics before undergoing urgent laparoscopic appendicectomy. The appendix was inflamed but not perforated, and histology showed appendicitis. She recovered without perioperative cardiovascular instability or progression to storm. This case shows the importance of distinguishing true surgical causes of abdominal pain from thyrotoxic presentations, assessing storm risk objectively, and stabilising hyperthyroid patients before urgent surgery. Early endocrine optimisation and coordinated multidisciplinary care can allow safe operative management despite severe thyrotoxicosis.