Tehran University Medical Journal

Background: Graves' disease is the most common cause (85% of all cases) of thyrotoxicosis in women in childbearing age. Many of the symptoms are similar to hyper-metabolic status during pregnancy. The cause of the disease is autoantibodies that stimulate the thyroid-stimulating hormone (TSH) receptor. Hyperthyroidism is uncommon in pregnancy and its prevalence is 0.1-%0.4. In this paper we introduce a patient who was admitted with a primary diagnosis of pulmonary embolism and treatment with final diagnosis of thyroid storm and was discharged with good condition.
Case presentation: In the first pregnancy of a 29-year-old woman with gestation age of 31 weeks was referred to obstetric emergency unit Ghaem Hospital, Mashhad, Iran in March 2015. She had Grave’s disease in her past medical history which was treated with methimazole before pregnancy and propylthiouracil (PTU) during pregnancy. In admission, she presented with tachycardia and tachypnea and hypertension and lower extremity edema. During pregnancy, she used propantheline instead of propylthiouracil due to pharmacy mistake. She admitted in Intensive care unit. After rule out of pulmonary embolism, ultrasonography showed a fetus with 30 weeks of gestational age with an approximate weight of 1680 grams. The amniotic fluid was reduced. She was treated with thyroid storm diagnosis due to a medication error. In serial obstetric visits fetal heart rate was not detected. Due to the fetal death, the pregnancy was terminated. Hyperthyroid therapy continued with PTU after delivery. She was discharged with a good general condition.
Conclusion: Despite the rarity of thyroid storm during pregnancy, in the event of unstable hemodynamic condition and cardiac dysfunction in pregnant women, rule out of thyroid disorders should be considered. Clinician should be paid attention to past drug history and underline disease of patient.

Background: Since pulmonary angiography is the only non-invasive method for diagnosing pulmonary embolism, the use of radiation reduction methods without affecting the quality of images seems necessary. One of the simplest reasons for unnecessarily increasing of patient exposure is repetitive imaging due to poor image quality. Therefore, it is necessary to identify and eliminate the factors that reduce the image quality, which leads to duplication of imaging or reduced accuracy.  In this study, the reasons for decreasing the image quality of pulmonary computed tomography (CT) angiography were investigated.
Methods: This cross-sectional study was performed over a period of 6 months (May to November 2018) in a university-affiliated hospital. Data of 75 patients suspected of pulmonary embolism who were referred for CT angiography were collected. All CT scans were performed by a 16-slice CT scanner (Lights Speed, GE Healthcare) with fixed imaging parameters including 100 kVp and 100 mA. In order to evaluate the adequacy of pulmonary artery enhancement, the Hounsfield unit (HU) of the main pulmonary artery was measured in the aortic arch, upper, and lower segmental parts. Also, 8 factors affecting the image quality were examined.