Endocrine Abstracts

Introduction: Pre-thrombotic states may be primary, related to a hereditary coagulation disorder or secondary (venous stasis or drug intake). We report a case of hyperthyroidism revealed by pulmonary embolism.

Observation: A 82-year-old woman, with a forty years history of type 2 diabetes mellitus, was admitted to the emergency room in a respiratory distress condition. The clinical examination found a dyspnoeic patient with tachycardia, hypertension, and a systolic murmur at the mitral focus, and the resting ECG showed atrial fibrillation. Pulmonary embolism was suspected, then confirmed by thoracic angioscan, which showed the presence of thrombus in the right middle lobe bronchus, and the segmental and sub segmental branch of the left lower lobe bronchus. Transthoracic ultrasound showed a normal size ventricle, a 50% ejection fraction, and a pulmonary arterial hypertension at 58 mmHg. The patient was put on anticoagulants and antihypertensive drugs. Obvious causes of pulmonary embolism have ben eliminated, the remaining suspected cause was hyperthyroidism, since the patient showed signs of thyrotoxicosis that have been evolving for 6 months. Moreover, the cervical examination revealed a medium sized and homogenous goiter. The diagnosis was confirmed: suppressed TSH at 0.02 mIU/ml, elevated FT4 at 73 ng/dl, and cervical ultrasound showed a multiheteronodular goiter. The patient was put on synthetic antithyroid drugs (Carbimazole). The patient showed signs of clinical, biological and ECG improvement.

Discussion: This association is rare. The advanced hypothesis is the disorders of hemostasis encountered in hyperthyroidism, especially the elevation of Von Willbrand factor and factor X activity.