Int J Thyroidol.  2021 May;14(1):63-68. 10.11106/ijt.2021.14.1.63.

A Case of an Elderly Graves’ Patient with Fatal Pulmonary Embolism

• Lee JY
• Yoo WS
• Chung HK

• KMID: 2516169
• DOI: http://doi.org/10.11106/ijt.2021.14.1.63

Abstract

In elderly Graves’ patients, thyrotoxicosis may have vague or atypical clinical features. It could delay the detection of Graves’ disease itself, and also other combined diseases. Here, we report a case of a 73-year-old Graves’ patient who complained of several atypical symptoms such as chest discomfort, pain in the lower calf, severe agitation, depression, sense of impending doom, myalgia etc. Despite these discomforts, they had previously been ignored as vague clinical features of Graves’ disease. After 4 months with hemoptysis, serious pulmonary embolism was confirmed by computed tomography of the chest, and the patient suddenly died. Clinicians should remember that the atypical symptoms in elderly Graves’ patients can suggest hidden comorbidities. This is especially critical in case of acute cardiovascular diseases such as pulmonary embolism, which can be fatal to elderly patients.

Keyword

Graves’ disease; Pulmonary embolism

Figure

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  Fig. 1 (A) Pulmonary embo-lism on a axial chest com-puted tomography (CT). There are filling defects in the right lower pulmonary artery (white arrow). (B) Anatomic location of the lesion (white arrow) is dis-played in a coronal CT image.

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  Fig. 2 Acute popliteal DVT on venous ultrasound. The popliteal vein is not compressed by the ultrasound trans-ducer because of passive distention by acute thrombus (white arrow) and no venous flow is noted. The thrombus appears homogeneous and has low echogenicity.

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