methimazole and Venous-Thrombosis

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Topics: Adolescent; Graves Disease; Humans; Hyperthyroidism; Intracranial Thrombosis; Ischemic Stroke; Magnetic Resonance Imaging; Male; Methimazole; Precipitating Factors; Sinus Thrombosis, Intracranial; Treatment Outcome; Venous Thrombosis

A 62-year-old woman with a history of partially treated Graves disease and hypertension presented with approximately 3 weeks of worsening fatigue, lower extremity myalgias, and shortness of breath. Her medical history included a thyroid radiofrequency ablation several years earlier. Following the ablation, she was found to have some residual thyroid activity, negating the need for therapy. She was lost to follow-up after months of normal thyroid-stimulating hormone values. On this presentation, the patient was noted to be in atrial fibrillation with a rapid ventricular rate, and although she presented alert and oriented initially, she developed progressive inattentiveness and confusion while in the ED. The patient was transferred to the medical ICU for further management of her rapid heart rate and progressive delirium.

Topics: Anti-Arrhythmia Agents; Anti-Inflammatory Agents; Anticoagulants; Antithyroid Agents; Atrial Fibrillation; Delirium; Disseminated Intravascular Coagulation; Dyspnea; Fatal Outcome; Fatigue; Female; Femoral Artery; Graves Disease; Heparin; Humans; Hydrocortisone; Ischemia; Lower Extremity; Methimazole; Middle Aged; Myalgia; Pneumoperitoneum; Popliteal Artery; Potassium Iodide; Propranolol; Radiofrequency Ablation; Thrombosis; Thyroid Crisis; Tibial Arteries; Venous Thrombosis

We present an interesting case of a patient with thyrotoxicosis who developed both arterial and venous thrombosis. Although there have been reports of thrombosis in such patients, there has been no case reporting arterial and venous thrombosis in the same patient. We describe the case and discuss the medical literature. We feel that any patient with unexplained hypercoagulability should be thoroughly evaluated for thyroid dysfunction.

Topics: Anticoagulants; Antithyroid Agents; Blood Coagulation; Humans; Infarction, Middle Cerebral Artery; Male; Methimazole; Middle Aged; Propranolol; Pulmonary Embolism; Thyrotoxicosis; Treatment Outcome; Venous Thrombosis

Topics: Antithyroid Agents; Female; Graves Disease; Humans; Methimazole; Middle Aged; Radionuclide Imaging; Ultrasonography; Venous Thrombosis

Recurrent deep venous thrombosis despite well conducted anticoagulant treatment is an uncommon, but possible, event. It has been hypothesized that overt hyperthyroidism may increase thromboembolic risk. We present the case of an elderly man with a recurrent episode of deep venous thrombosis during optimal oral vitamin K antagonist treatment, associated with a new diagnosis of overt hyperthyroidism, with no evidence of occult cancer and normal levels of antiphosholipid antibodies.

Topics: Aged; Anticoagulants; Antithyroid Agents; Humans; Hyperthyroidism; Male; Methimazole; Recurrence; Venous Thrombosis; Warfarin