Renal and Splenic Infarction Associated with Hyperthyroidism

Korean Journal of Nephrology 2011;30(5):528-532.

Seo Rin Kim, M.D.1, Choi Bo Kyung, M.D.2, Il Young Kim, M.D.2, Jung Min Son, M.D.1, Eun Youg Seong, M.D.2, Sang Heon Song, M.D.2, Dong Won Lee, M.D.2, Soo Bong Lee, M.D.2 and Ihm Soo Kwak, M.D.2

BHS Hanseo Hospital¹
Busan ; Department of Internal Medicine²
Pusan National University School of Medicine, Yangsan, Korea

증례 : 갑상선기능항진증에 동반된 신경색과 비장경색 1예

김서린1 , 최보경2 , 김일영2 , 손정민1 , 성은영2 , 송상헌2 , 이동원2 , 이수봉2 , 곽임수2

BHS 한서병원1 , 부산대학교 의학전문대학원 내과학교실2

Abstract

A 59-year-old female was admitted with left flank pain. She had heat intolerance and dyspnea for the last 3 years. She was diagnosed as having renal and splenic infarction. 2 phase computed tomography (CT) scan on abdomen and pelvis showed a non-enhancing portion at the anterior aspect of the left kidney and multifocal low density at the spleen. Laboratory examinations revealed TSH 0.0004 uIU/ mL, Free T4 2.69 ng/dL, T3 1.67 ng/mL, anti TPO antibody 207 U/mL (positive), anti TG antibody 52.7 U/mL (positive) and TSH receptor antibody >40 U/mL. A diagnosis of hyperthyroidism was made. Factor VIII activity increased over 160% (normal range 60-140), which has been known to increase in the cases of hyperthyroidism. Except for an increased factor VIII activity there were no thrombogenic abnormalities. She recovered well after the treatment with methimazole in addition to warfarin followed by intravenous heparin. This case is consistent with the assumption that hyperthyroidism, probably through a factor VIII-mediated hypercoagulability, may be a predisposing factor for the development of renal and splenic infarction.

Key Words: Infarction, Hyperthyroidism, Factor VIII