Endocrine Abstracts

Introduction: There are few cases about arterial thrombosis combined with thyrotoxicosis independent of atrial arrhythmias. Herein, we report a case of Graves’ disease presented with renal artery infarction withiout atrial fibrillation.

Case: A 54-year-old man visited the emergency department due to the sudden onset of left flank pain for 30 min. The left flank pain was accompanied by sole dysuria without other symptoms of pyelonephritis. Physical examination showed neck enlargement and eyeball protrusion. He did not have any medical history of diabetes, hypertension, or cardiovascular disease. Vital signs were as follows:blood pressure- 140/90 mmHg, heart rate-108 bpm, respiration rate-22/min, body temperature- 36.5°C. The electrocardiogram (ECG) showed normal sinus rhythm and tachycardia, and chest X-ray was unremarkable. Laboratory findings were as follows: urinary analysis-5–9 RBC/HPF, +1 proteinuria. TSH-0.01 uU/ml (0.55–4.78), freeT₄− 28.33 pmol/l (11.5–22.7), anti-TSH receptor antibody (TSI)-40.00 IU/l (~1.75). Other results were within normal range. Abdominal CT with enhancement showed hypoechoic lesion with clear margin of wedge shape on the left kidney and there was thrombus in left renal artery. Renal artery infarction was diagnosed based on his symptoms and typical CT finding. The patient was treated with intravenous unfractionated heparin infusion. Holter monitoring and echocardiogram showed normal findings. Thyroid ultrasonography showed increased size and vascularity of both thyroid gland. Technetium-99m thyroid scan was also compatible to the Graves’ disease. The patient was treated with methimazole and switched to warfarin therapy after 5 days of heparin infusion.

Conclusion: Although the clear relationship between arterial thrombosis, especially renal artery infarction, and hyperthyroidism needs to be clarified in the future, our case suggests that uncontrolled thyrotoxicosis can be associated with a risk of renal artery infarction.