Rectal administration of propylthiouracil in suppository form in patients with thyrotoxicosis and critical illness: case report and review of literature.

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. 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. 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. 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.