Laparoscopic salvage in a storm: A multidisciplinary case report of thyroid storm complicated by gastrointestinal perforation

Thyroid storm (TS) is a critical endocrine emergency characterized by multiorgan failure. Although rare, gastrointestinal perforation is a catastrophic complication that frequently leads to diagnostic delays and poor prognosis. This case provides valuable clinical insights based on a multidisciplinary strategy and well-considered surgical timing. A 22-year-old male with poorly controlled hyperthyroidism presented with acute abdominal pain, fever, and altered mental status. He was diagnosed with TS based on clinical scoring (Burch-Wartofsky Point Scale) and laboratory markers. Imaging confirmed gastrointestinal perforation. A multidisciplinary team initiated immediate medical stabilization using beta-blockers, antithyroid drugs, corticosteroids, and supportive care. Definitive treatment with laparoscopic repair was performed after clinical optimization under tailored anesthesia. The patient achieved complete recovery and was discharged on postoperative day 10, with normalization of thyroid and inflammatory markers. This case emphasizes the importance of suspecting TS in acute abdomen cases with hyperthyroid history; that cautious surgical delay may be justified to optimize outcomes in TS; and that minimally invasive surgery combined with individualized anesthesia is feasible in this high-risk population.