Introduction: Hypothyroidism is a common endocrine disorder worldwide. Its treatment is with oral thyroxine, but when this route cannot be utilised then intravenous thyroxine is an alternate but not available in some countries so rectal thyroxine administration can be used but clinical experience is lacking.
Case report: This is a case of a 55-years-old Pakistani male known case of hypothyroidism since July 2007 and was maintaining normal TSH and FT4 level on thyroxine 125 μg per day. He was diagnosed as recurrent laryngeal carcinoma and planned to undergo change of tracheostomy and feeding gastrojejunostomy surgery. As he was unable to take oral referred for hypothyroid medical optimisation prior to surgery. On presentation he was constipated, lethargic had tracheostomy and was on total parental nutrition and not taking his thyroxine for last one month. His TSH was >150uIU/ml and FT4 was 0.44 ng/dl. As the intravenous thyroxin was not available was started on rectal suppository of thyroxin 250 μg per day. The dose of rectal thyroxine gradually increased to 500 μg per day and his TSH level dropped to 8.83 uIU/ml and FT4 level raised to 1.29 ng/dl and patient underwent successfully for gastrojejustomy and started him on thyroxine 125 mcg per day through gastrojeunostmy tube and maintaining normal TSH and FT4 level.
Conclusion: Patients with hypothyroidism can be managed with rectal thyroxine responses are variable as in our case required four times the oral dose.