Endocrine Abstracts

Introduction

Basedow disease is the most common etiology of hyperthyroidism; the cardiac manifestations seen in hyperthyroidism often affect people over 60 years of age, manifested mainly by sinus tachycardia, atrial rhythm disturbances or increased cardiac output. Pulmonary arterial hypertension and pulmonary embolism are atypical manifestations.

Observation

39-year-old patient, followed for basedow disease for 14 years on carbimazole 20 mg/day, Basedowian orbitopathy for 2 years having received corticosteroid boluses. Clinically, the patient presented with bilateral exophthalmos, sinus tachycardia, tremors, and pretibial myxedema. Palpation found a homogeneous goiter. TSH was collapsed with T4L at 0.7 µg/ml and positive TSH receptor antibodies 40 IU/l. During hospitalization, the patient developed dyspnea. The cardiac ultrasound revealed significant pulmonary hypertension at 73 mmHg, and increased cardiac output. A pulmonary CT angiogram revealed a bilateral basal sub-segmental pulmonary embolism with the presence of a submerging thyroid goiter. The patient was put on LMWH curative dose with good clinical outcome. The dose of carbimazole was reduced to 10 mg/day.

Conclusion

Basedow disease, a potentially serious endocrinopathy, leads to a prothrombotic and hypofibrinolytic state. This observation underlines the importance of determining the place of this risk factor within the various risk factors of thrombotic disease already known and the need to put in place preventive strategies for thrombosis.