Gloria Erazo, MD1, Ooreoluwa Fasola, MD1, Daniel Guifarro Rivera, MD2, Guy Loic Nguefang Tchoukeu, MD1, Edgar Luna Landa, MD1, Romelia A. Barba Bernal, MD3, Sheharyar Merwat, MD4 1Texas Tech University Health Sciences Center, Odessa, TX; 2Cook County Health and Hospital Systems, Chicago, IL; 3Texas Tech University Health Sciences Center, Lubbock, TX; 4Medical Center Hospital, Odessa, TX Introduction: Thyroid disease has been associated with various gastrointestinal (GI) symptoms, including gastritis, ileus, constipation, and, rarely, ischemic colitis. While GI bleeding secondary to mesenteric ischemia has been documented, gastric ischemia remains an exceptionally rare cause.
Case Description/
Methods: We described a case of ischemic gastritis associated with severe hypothyroidism. A 61-year-old woman with a history of bilateral thyroid nodules and chronic non-healing lower extremity wounds presented with lethargy, confusion, hypothermia, and bradycardia, consistent with myxedema coma. She was treated with IV levothyroxine and hydrocortisone. During her hospitalization, she underwent successful endovascular intervention for peripheral vascular disease but subsequently developed recurrent hematemesis and hemodynamic instability. EGD revealed severe ischemic gastritis and duodenitis with denuded and erosive mucosa. Figure 1. CT angiography demonstrated significant atherosclerotic stenosis of the celiac and superior mesenteric arteries, but revascularization was deferred due to contraindications to dual antiplatelet therapy. Remarkably, after thyroid function was corrected, a follow-up EGD performed three months later showed spontaneous resolution of ischemic gastritis. Figure 2. Discussion: This case highlights a possible association between severe hypothyroidism and gastric ischemia and underscores the importance of considering endocrine dysfunction as a reversible cause of ischemic gastrointestinal injury. Early recognition and targeted management of underlying thyroid disease may be critical in selected patients with unexplained gastric ischemia.
Figure: Figure 1. EGD revealed severe ischemic gastritis and duodenitis with denuded and erosive mucosa.
Figure: Figure 2. EGD performed three months later showed spontaneous resolution of ischemic gastritis.
Disclosures: Gloria Erazo indicated no relevant financial relationships. Ooreoluwa Fasola indicated no relevant financial relationships. Daniel Guifarro Rivera indicated no relevant financial relationships. Guy Loic Nguefang Tchoukeu indicated no relevant financial relationships. Edgar Luna Landa indicated no relevant financial relationships. Romelia Barba Bernal indicated no relevant financial relationships. Sheharyar Merwat indicated no relevant financial relationships.
Gloria Erazo, MD1, Ooreoluwa Fasola, MD1, Daniel Guifarro Rivera, MD2, Guy Loic Nguefang Tchoukeu, MD1, Edgar Luna Landa, MD1, Romelia A. Barba Bernal, MD3, Sheharyar Merwat, MD4. P5228 - Gastric Ischemia: A Rare Presentation of Severe Hypothyroidism, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
