Endocrine Abstracts

Objective: We report two cases of thyrotoxicosis with use of anti-thyroid medications via rectum in elderly patients where oral or naso-gastric route was unavailable.

Discussion: Case 1: An 86-year-old woman was admitted in July 2007 with confusion associated with agitation and tachycardia. She had a known history of thyrotoxicosis. At the time of this admission, the TFTs were once again found to be abnormal (Table 1) and she was started on PTU. During admission, due to her psychiatric problems of depression and cognitive impairment she started to refuse food and medications (including PTU). The situation could not be improved despite interventions from psychiatric services. We started her on rectal PTU 200mg daily with improvement in the TFTs (Table 1). Unfortunately, she later died due to her other medical problems.

Case 2: An 81-year-old male was admitted in September 2007 with suspected CVA resulting in swallowing difficulties. He was diagnosed to have thyrotoxicosis, 2 months prior to this admission and was commenced on carbimazole. Due to swallowing difficulties his medication were initially administered via a naso-gastric tube. However, he pulled the tube on several occasions. At this stage, he was started on PTU per rectum.

Conclusion: Rectal administration of anti-thyroid medications is effective and well-tolerated alternative route to manage thyrotoxicosis when the option of oral administration is unavailable.