Sažetak sa skupa

https://doi.org/10.15836/ccar2019.244

Overt hyperthyroidism and venous thrombosis: what is the association?

Chakir Mariame ; University Hospital Mohammed the VIth, Department of Cardiology, Marrakesh, Morocco

Sažetak

Introduction: Patients that present overt hyperthyroidism, are more prone to a venous or arterial
thrombosis1-3. Multiple mechanisms can explain the procoagulant changes in the hemostatic system
in this population. Hereby, we report the case of a patient with Grave’s disease, presenting overt hyperthyroidism,
associated with pulmonary embolism. The aim of this report is to emphasize the pathophysiological
patterns responsible of the emergence of venous thrombosis (VT) in hyperthyroidism, as
well as to discuss the increased probability of VT in this population.
Case report: 44-year-old woman, with a past medical history of Grave’s disease, treated during the
previous year before her admission by carbimazole 30 mg daily, presented to the emergency department
with a fever, productive cough, hemoptysis and painful breathing during the last couple of days.
In the previous weeks she had noticed swelling and redness of her right leg. The diagnosis of VT of the
lower limb was confirmed by a venous ultrasound of the lower extremities and she was put on vitamin
K antagonists 10 days before she presented to the emergency department for her exertional dyspnea.
No risk factors for venous thrombosis were present. On physical examination she had a breathing
frequency of 30 per minute, an air saturation of 92%, a temperature of 38.6 °C and, pulse rate of 120
beats per minute. The ECG showed a sinus tachycardia of 120 bpm and an S1Q3 aspect. CT scan has
shown proximal right pulmonary emboli in the right upper and lower lobe with infarction of the basal
right lung. Laboratory data revealed a TSH of 0.005mE/l and FT4 of >70 pmol/l. The thrombophilic tests
were negative. The patient received heparin, followed by oral anticoagulant therapy with a vitamin K
antagonist with a favorable evolution. By presenting this case, our aim is to emphasize the fact that
hyperthyroidism can be a risk factor for venous thromboembolism, as indicated previously by a small
number of retrospective studies. This patient had no identifiable risk factors for VTE. Possible predisposing
factors for the development of VT and PE in patients with thyrotoxicosis are also in line with
Virchow’s triad.
Conclusion: Patients with hyperthyroidism may often have accompanying endothelial dysfunction,
decreased fibrinolytic activity, and hypercoagulable states which contribute to the development of VT.

Ključne riječi

hyperthyroidism; venous thrombosis; pulmonary embolism.

Hrčak ID:

226713

URI

https://hrcak.srce.hr/226713

Datum izdavanja:

15.10.2019.

Posjeta: 924 *