Kim Tong-Yoon, Ihm Sang-Hyun, Roh Ji Woong, Lim Sungmin, Park Chan-Seok, Kim Hee-Yeol
Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-Ro, Womni-Gu, Bucheon-Si, Gyunggi-Do 14647 Republic of Korea.
Clin Hypertens. 2020 Sep 1;26:17. doi: 10.1186/s40885-020-00150-2. eCollection 2020.
Pulmonary thromboembolism (PTE) is thought to usually stem from deep vein thrombosis (DVT). However, evidence of DVT could not be found in many cases. Furthermore, transient thyrotoxicosis is a rare but potentially life-threatening emergency involving a systemic hypercoagulable state. We report on an 18 year-old-girl with transient thyrotoxicosis with massive PTE without DVT.
An 18-year-old girl was admitted to the hospital with syncope. Patient had no history of trauma, any known underlying disease or oral contraceptives use. Chest computed tomography (CT) showed massive PTE in both central pulmonary arteries and diffuse goiter. However, a low extremity Doppler sonogram did not detect DVT. To manage the PTE, we administered low molecular weight heparin. On the other hands, thyroid function test indicated a state of thyrotoxicosis. In addition, patient had a partial protein S deficiency but no other immunologic abnormality. Therefore, the patient was diagnosed with massive PTE, thyrotoxicosis, and partial protein S deficiency. Patient was discharged with oral warfarin and methimazole. A follow-up echocardiogram obtained 3 months after anticoagulation therapy demonstrated normal dimensions and systolic function. After thyrotoxicosis was treated with methimazole for a month, a euthyroid state was achieved and the goiter decreased to a normal size. The methimazole was gradually tapered off and stopped at 4 months. At a 6-month follow up visit, PTE and pulmonary hypertension had disappeared but the patient still had a partial protein S deficiency. We decided to stop all medication with careful monitoring. During a 4-year follow-up period after the episode, she was asymptomatic without any evidence of recurrent systemic thromboembolism or hyperthyroidism.
Early recognition and appropriate treatment of PTE combined with transient thyrotoxicosis were vital to preventing other complications.
肺血栓栓塞症（PTE）通常被认为起源于深静脉血栓形成（DVT）。然而，在许多病例中并未发现DVT的证据。此外，短暂性甲状腺毒症是一种罕见但可能危及生命的紧急情况，涉及全身高凝状态。我们报告一例18岁女孩，患有短暂性甲状腺毒症并伴有无DVT的大面积PTE。
一名18岁女孩因晕厥入院。患者无创伤史、任何已知基础疾病或口服避孕药使用史。胸部计算机断层扫描（CT）显示双侧中央肺动脉大面积PTE和弥漫性甲状腺肿。然而，下肢多普勒超声检查未检测到DVT。为治疗PTE，我们给予低分子肝素。另一方面，甲状腺功能检查显示甲状腺毒症状态。此外，患者存在部分蛋白S缺乏，但无其他免疫异常。因此，该患者被诊断为大面积PTE、甲状腺毒症和部分蛋白S缺乏。患者出院时服用口服华法林和甲巯咪唑。抗凝治疗3个月后进行的随访超声心动图显示心脏大小和收缩功能正常。用甲巯咪唑治疗甲状腺毒症1个月后，达到甲状腺功能正常状态，甲状腺肿缩小至正常大小。甲巯咪唑逐渐减量并在4个月时停药。在6个月的随访中，PTE和肺动脉高压消失，但患者仍存在部分蛋白S缺乏。我们决定在密切监测下停用所有药物。在该事件后的4年随访期内，她无症状，无任何复发性全身血栓栓塞或甲状腺功能亢进的证据。
早期识别并适当治疗PTE合并短暂性甲状腺毒症对于预防其他并发症至关重要。
