Uncommon presentation of combined Graves' disease and Pulmonary embolism in a 32-year-old woman
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
30
Journal Issue
5
Pages
351-357
Date Issued
2019
Author(s)
Abstract
Pulmonary embolism (PE) is related to hypercoagulable status, such as malignancy, nature anticoagulant deficiency, pregnancy and use of estrogen replacement. It has rarely been reported to be associated with endocrine diseases. We presented a 32-year-old woman with combined Graves' disease and PE. The initial presentation was progressive exertional dyspnea and cough for one month. First impression was Graves' disease complicated with thyrotoxic crisis at the emergency department, but PE was suspected clinically. A dilemma of diagnostic process was the use of iodine-containing contrast media. Increasing iodine uptake of thyroid glands would lead to potential exacerbation of thyrotoxicosis, but PE is usually diagnosed with a contrast-enhancing computed tomography (CT) of chest. We demonstrated a good result of combined treatment for Graves' disease with anti-thyroid drugs and submassive PE with catheter-directed thrombolysis and anticoagulants. After extensive literature review, we hypothesized that hyperthyroidism per se may contribute to the development of PE. ? 2019 Society of Internal Medicine of Taiwan. All rights reserved.
SDGs
Other Subjects
amino terminal pro brain natriuretic peptide; bilirubin; blood clotting factor 8; C reactive protein; carbimazole; ceftriaxone; D dimer; enoxaparin; furosemide; hydrocortisone; immunoglobulin; lugol; methylprednisolone; piperacillin plus tazobactam; propranolol; propylthiouracil; radioactive iodine; recombinant thyrotropin; rivaroxaban; thyroid peroxidase antibody; thyroxine; abnormal respiratory sound; adult; antibiotic therapy; anticoagulant therapy; Article; cardiomegaly; case report; clinical article; community acquired pneumonia; contrast enhancement; coughing; diaphoresis; disease activity; drug pulse therapy; dyspnea; electrocardiogram; emergency ward; euthyroidism; female; femoral vein; fever; flushing; follow up; free thyroxine index; Graves disease; heart palpitation; hemoptysis; hospital acquired pneumonia; human; hyperbilirubinemia; hyperthyroidism; leg swelling; leukocytosis; loose feces; lower leg; lung embolism; lung infarction; lung scintiscanning; nose obstruction; physical examination; rhinorrhea; sinus tachycardia; skin disease; steroid therapy; systolic blood pressure; systolic heart murmur; thorax radiography; thyroid crisis; transthoracic echocardiography; tricuspid valve regurgitation; vein thrombosis; x-ray computed tomography
Publisher
Society of Internal Medicine of Taiwan
Type
journal article