Hyperthyroidism: A rare cause of pulmonary embolism: Report of two cases
A 23-year-old female patient, whose sister was affected by Graves’ disease, had been treated since 2007 for Graves’ disease. This diagnosis was made on the basis of hyperthyroid symptoms, moderate homogenous and elastic goiter, elevated FT4 level (94.9 pmol/L, normal range 10-24) with suppressed TSH (0.05 μU/mL, normal range 0.4-4.5), and elevated titer of antithyroid-stimulating antibodies (43.3 UI/L, normal range <2).\nThe patient was put under antithyroid drugs: Benzylthiouracil (Basdène®) at a dose of 225 mg daily in combination with a beta-blocker (Propranolol, 60 mg daily). The patient showed poor compliance and frequent discontinuation of her treatment. Facing the reappearance of hyperthyroidism, she was hospitalized in June 2010. On examination, she had a body mass index of 21.38 kg/m2, BP of 140/80 mmHg. In addition to the signs of thyrotoxicosis, the patient had a moderate bilateral exophthalmos associated with a moderate homogenous and vascular goiter. Her ECG showed sinus tachycardia with right axis deviation, and Sokolow-Lyon criteria for left ventricular hypertrophy.\nOn hormonal investigations, FT4 was higher than 100 pmol/L (normal range 10-24) and TSH was 0.005 μU/mL (normal range 0.4-4.5). During hospitalization, the patient developed a severe chest pain, dyspnea with an exaggeration of tachycardia. ECG showed right bundle branch block. Chest radiography revealed no abnormalities. Arterial blood gas analysis showed hypoxia and hypocapnia. Serum level of D-Dimer was higher than 500 ng/ml. PE was suspected and was confirmed by a lung perfusion-ventilation scan test confirmed which showed several bilateral segmental perfusion defects []. The patient was put under heparin relayed by anticoagulants. In addition, radioactive iodine treatment was administered (7 mCi), and then the patient was again put under Benzylthiouracile. Etiological investigation of PE has revealed a 200% elevation of plasma concentration of coagulation factor VIII. The patient consulted three months following radioiodine treatment without any hormonal tests. She was clinically euthyroid, and since then she was lost to follow-up.