Abstract
RATIONALE: 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. PATIENT CONCERNS: A 22-year-old male with poorly controlled hyperthyroidism presented with acute abdominal pain, fever, and altered mental status. DIAGNOSES: He was diagnosed with TS based on clinical scoring (Burch-Wartofsky Point Scale) and laboratory markers. Imaging confirmed gastrointestinal perforation. INTERVENTIONS: 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. OUTCOMES: The patient achieved complete recovery and was discharged on postoperative day 10, with normalization of thyroid and inflammatory markers. LESSONS: 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.