Endocrine Abstracts (2015) 37 EP1260 | DOI: 10.1530/endoabs.37.EP1260

Hypercoagulable state: an evidence of linkage with hyperthyroidism

Kunjang Sherpa, Robin Maskey, Prahlad Karki, Deebya Raj Mishra, Denish Peeyush & Naveen Pandey

B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

Introduction: Hyperthyroidism is not a widely recognised association with Venous thromboembolism (VTE). However, Several previous studies suggest that hyperthyroidism represent a potential hypercoagulable and hypofibrinolytic state, which may contribute to the increased risk of thromboembolism.

Case report: A 39-year-old lady presented with Swelling over bilateral lower limbs for 1 month, Palpitation for 1 month. She had history of swelling over neck for last 13 years and protrusion of bilateral eye for 13 years, history of increased sweating, anxiety, and weight loss of about 10 kg in last 6 months. On examination patient had staring appearance, atrial fibrillation, She also had pallor, bilateral exophthalmos (‘NO SPECS’-2), Diffuse goiter bilateral and non pitting pedal edema with hyperpigmented plaques over dorsum of leg and foot. Investigation revealed thyroid function test- TSH=<0.05 mIU/l, fT3=29.8 pmol/l, fT4=>100 pmol/l and anaemia (haemoglobin of 9 mg/dl). Venous Doppler ultrasound (USG) revealed presence of an echogenic thrombus in bilateral lower limb extending into femoral vein in right side and up to popliteal vein in left side and USG neck showed diffusely enlarged thyroid gland with heterogenous echotexture with increased vascularity. The patient was treated with antithyroid drugs,anticoagulants, and β-blockers. The patient improved clinically with normalization of thyroid function.

Taken with permission

Conclusion: Our case report reinforces the available evidence on the possible role of overt hyperthyroidism as VTE risk factor. It seems worthwhile to measure thyroid hormones in patients with unprovoked venous thromboembolic event and in contrarily the diagnosis of venous thromboembolism should be considered in patients with hyperthyroidism, particularly if additional prothrombotic risk factors are present.

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