Autoimmune Hypothyroidism Presenting as Subacute Intestinal Obstruction: A Case Report and Literature Review.

Hypothyroidism is associated with multiple gastrointestinal manifestations, ranging from mild constipation to rare life-threatening complications such as paralytic ileus and intestinal pseudo-obstruction. We report a case of a 41-year-old male patient with severe autoimmune hypothyroidism presenting with persistent abdominal distension and subacute intestinal obstruction secondary to fecaloma and colonic ileus. The diagnosis was initially obscured by concomitant diabetic ketoacidosis (DKA) and electrolyte disturbances. Despite resolution of DKA and multiple bowel decompression procedures, gastrointestinal symptoms persisted until hypothyroidism was recognised and treated with levothyroxine. This case highlights the importance of considering endocrine causes, particularly severe hypothyroidism, in patients with unexplained intestinal dysmotility and bowel obstruction.