S4775 Gastric Ischemia: A Rare Presentation of Severe Hypothyroidism

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 intravenous levothyroxine and hydrocortisone. During her hospitalization, she underwent successful endovascular intervention for peripheral vascular disease but subsequently developed recurrent hematemesis and hemodynamic instability. esophagogastroduodenoscopy (EGD) revealed severe ischemic gastritis and duodenitis with denuded and erosive mucosa. Computed tomography 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 3 months later showed spontaneous resolution of ischemic gastritis. 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.