VWF and endothelial dysfunction: Incidentally, there are even fewer case reports reported on the development of pulmonary embolisms (PEs) associated with Graves' disease [3-5]. Hypercoagulability can be observed in hyperthyroid states and is attributed to elevated levels of serum fibrinogen, von Willebrand factor (vWF), and factor VII in addition to compounding endothelial dysfunction and decreased fibrinolytic activity [6-8].