Refractory gastrointestinal bleeding treated with thyroid hormone replacement.

Although bleeding diathesis has been associated with hypothyroidism, refractory gastrointestinal bleeding has not been previously described in association with hypothyroidism. We report a patient who presented with refractory gastrointestinal bleeding over an 8-week period. Extensive work-up demonstrated small intestinal vascular malformations as the source of bleeding. Despite endoscopic therapy and hormonal therapy, bleeding continued and required transfusion of 54 units of packed red blood cells. Surgical therapy was offered to the patient but was declined. Ultimately, correction of the patient's underlying hypothyroidism resulted in cessation of gastrointestinal bleeding, and no further blood transfusion was necessary. To date, the patient has remained euthyroid without further gastrointestinal bleeding for 30 months.