Increased ileostomy output as an indicator of thyroid storm in a patient without an established history of underlying thyroid disease

Background: Thyroid storm, also known as thyrotoxic crisis, is a rare but life-threatening endocrine emergency that presents with multisystem involvement. Patients present with pronounced signs of hyperthyroidism, fever, tachycardia, and differing severities of multisystem dysfunction and decompensation. Early recognition and prompt initiation of treatment are important. The development of thyroid storm in patients with no established history of underlying hyperthyroidism is rare. In this case report, we describe the occurrence of thyroid storm in a 27-year-old man without an established history of underlying thyroid disease, who was admitted to the Intensive Care Unit (ICU) with a high ileostomy output and fever. Although initially treated for possible sepsis, the diagnosis of thyroid storm was made only after a thorough workup was initiated and he was found to have underlying Graves’ disease. Prompt treatment resulted in the resolution of symptoms and avoided potential morbidity and mortality. This case highlights the potential difficulty in diagnosing thyroid storm in a patient admitted to the ICU without an established history of hyperthyroidism. Upgrade in care, timely diagnosis, and initiation of appropriate therapy led to a favorable outcome. Clinicians should consider hyperthyroidism as a possible cause of high ileostomy output, especially when it does not resolve with traditional treatment and no obvious cause can be identified. This case demonstrates the challenges presented when the patient’s history and clinical signs are ambiguous and stresses the importance of “outside the box” thinking.