title: Rectal administration of propylthiouracil in suppository form in patients with thyrotoxicosis and critical illness: case report and review of literature.
abstract: OBJECTIVE
  To report the successful management of thyrotoxicosis in a seriously ill 47-year-old man with a perforated gastric ulcer in whom oral intake was contraindicated.
  
  
  METHODS
  Our patient was treated with 400 mg of propylthiouracil (PTU) every 6 hours in the form of specially prepared suppositories for rectal administration, together with intravenously infused esmolol.
  
  
  RESULTS
  We were able to demonstrate substantial absorption of PTU administered by means of rectal suppositories. Serum levels of PTU were maintained within the high therapeutic range for 5 days until the patient was able to tolerate orally administered therapy. The patient improved clinically during this treatment.
  
  
  CONCLUSIONS
  This case strongly supports the rectal administration of PTU in suppository form as an appropriate alternative route in any patient with thyrotoxicosis, including the critically ill patient, when oral administration is not possible.
authors.affiliation: Department of Medicine, Division of Endocrinology and Metabolism, Beth Israel Medical Center, University Hospital and Manhattan Campus for the Albert Einstein College of Medicine, New York, New York 10003, USA.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Zweig
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Schlosser
authors.forename: Sylvia A
authors.initials: SA
authors.lastname: Thomas
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Levy
authors.forename: Adrienne M
authors.initials: AM
authors.lastname: Fleckman
mesh_terms: D000285:Administration, Rectal; D016638:Critical Illness; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis*; D011441:Propylthiouracil / Q000008:administration & dosage*; D018570:Risk Assessment; D013276:Stomach Ulcer / Q000150:complications* / Q000175:diagnosis; D013488:Suppositories; D013971:Thyrotoxicosis / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D013488:Suppositories; D011441:Propylthiouracil