Abstract
Typical presenting symptoms of hyperthyroidism are fatigue, nervousness, anxiety, weight loss, palpitation and heat sensitivity; hyperemesis and nausea are sometimes associated [ [1] Cooper D.S. Hyperthyroidism. Lancet. 2003; 362: 459-468 Abstract Full Text Full Text PDF PubMed Scopus (373) Google Scholar ]. Hyperthyroidism is hypothesized to increase the risk of venous thromboembolic events. We report a case of a woman with typical symptoms of hyperthyroidism who developed a superficial vein thrombosis. A 50-year-old Asian woman was referred for a right calf pain to our Thrombosis Unit on December 31st 2006. The patient was concomitantly complaining nausea and vomiting, and an 8 kilograms-weight loss in the past 3 months. A venous compression ultrasound showed a superficial vein thrombosis of a variceal vein of the right calf. Neither temporary nor permanent thromboembolic risk factors were identified, but a previous superficial vein thrombosis on September 2nd 2003. Neoplastic markers were within the reference range and faecal occult blood was absent On October 2003, anticardiolipin antibodies, anti-β2 glycoprotein I antibodies, and lupus anticoagulant antibodies dosage were within the reference range. Thyroid hormones test showed an overt hyperthyroidism: thyrotropin (TSH) was 0.06 μIU/ml (reference range [r.r.] 0.31–4.50), free triiodothyronine value of 18.47 pg/mL (r.r. 1.50–5.30), and serum free thyroxine value of 3.73 ng/dL (r.r. 0.75–1.90); anti-thyroid peroxidase, antithyroglobulin, and anti-TSH receptor antibodies were not elevated. Thyroid ultrasound showed a gland symmetrically enlarged with micronodular aspect; thyroid scintigraphy with 99 mTc demonstrated images of a typical Graves-Basedow disease. The patient was started on thiamazole.
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