Rayan Melanie N, Jones Tyler S, Ruiz de Villa Ariel, Calestino Matthew, Bazikian Yvette
Internal Medicine, University of Central Florida College of Medicine/HCA Florida North Florida Hospital, Gainesville, USA.
Cureus. 2022 Apr 7;14(4):e23935. doi: 10.7759/cureus.23935. eCollection 2022 Apr.
Venous thromboembolism is a common, yet serious life-threatening condition that has many well-recognized associations which include but are not limited to pregnancy, polycythemia, trauma, immobility, and malignancy. The pathophysiology behind the pro-coagulant effects of hyperthyroidism has been well established; however, there are no current guidelines regarding deep venous thrombosis (DVT) surveillance in patients with hyperthyroidism. In this report, we discuss the case of a 36-year-old female with no significant past medical history (PMH) with the exception of a 15 pack-year smoking history, who presented to us with an extensive, rapidly-progressing lower extremity DVT. Despite aggressive treatment measures, she developed a pulmonary embolus in the hospital. During her stay, she was diagnosed with Graves' disease by hormone profile and thyroid-stimulating hormone receptor (TSH-R) antibody positivity. Additionally, an incidental thymic mass, likely thymic hyperplasia, was found on imaging and presumed to be associated with Graves' disease. This case study reports a difficult-to-treat venous thromboembolism in the setting of Graves' disease along with a review of current literature and pathophysiology on the subject.
静脉血栓栓塞是一种常见但严重的危及生命的疾病，有许多公认的相关因素，包括但不限于妊娠、红细胞增多症、创伤、制动和恶性肿瘤。甲状腺功能亢进促凝作用背后的病理生理学已得到充分证实；然而，目前尚无关于甲状腺功能亢进患者深静脉血栓形成（DVT）监测的指南。在本报告中，我们讨论了一名36岁女性的病例，该女性除有15年的吸烟史外，无重大既往病史（PMH），她因广泛、迅速进展的下肢DVT前来就诊。尽管采取了积极的治疗措施，但她在医院发生了肺栓塞。住院期间，通过激素水平和促甲状腺激素受体（TSH-R）抗体阳性诊断为格雷夫斯病。此外，影像学检查发现一个偶然的胸腺肿块，可能是胸腺增生，推测与格雷夫斯病有关。本病例报告了格雷夫斯病背景下难以治疗的静脉血栓栓塞，并对该主题的当前文献和病理生理学进行了综述。
