葛瑞夫茲氏病(Graves’ disease) 是一種自體免疫性的甲狀腺疾病，患者的表現多以甲狀腺亢進的病徵為主。肺栓塞(pulmonary embolism) 則多與高凝固性血液(hypercoagulability)、惡性腫瘤(malignancy) 及靜脈血液滯留(venous stasis) 有相關性，而治療方面則以抗凝血劑的使用為主。我們的病例報告中，病人同時合併有葛瑞夫茲氏病及肺栓塞，使我們面臨診斷工具上的困境，因為以注射含碘顯影劑之電腦斷層來診斷肺血栓栓塞，可能會惡化甲狀腺亢進的病徵。在適時診斷後，經過抗甲狀腺藥物(anti-thyroid drugs) 及導管導引血栓溶解(catheter-directed thrombolysis) 和抗凝血劑(anticoagulants) 等治療後，患者的病情獲得良好的改善及控制。經由廣泛文獻回顧，我們提出假設，甲狀腺亢進本身可能導致患者的高凝固性血液狀態。

Pulmonary embolism (PE) is related to hypercoagulable status, such as malignancy, nature anticoagulant deficiency, pregnancy and use of estrogen replacement. It has rarely been reported to be associated with endocrine diseases. We presented a 32-year-old woman with combined Graves’ disease and PE. The initial presentation was progressive exertional dyspnea and cough for one month. First impression was Graves’ disease complicated with thyrotoxic crisis at the emergency department, but PE was suspected clinically. A dilemma of diagnostic process was the use of iodine-containing contrast media. Increasing iodine uptake of thyroid glands would lead to potential exacerbation of thyrotoxicosis, but PE is usually diagnosed with a contrast-enhancing computed tomography (CT) of chest. We demonstrated a good result of combined treatment for Graves’ disease with anti-thyroid drugs and submassive PE with catheter-directed thrombolysis and anticoagulants. After extensive literature review, we hypothesized that hyperthyroidism per se may contribute to the development of PE.