Subclinical hypothyroidism and deep venous thrombosisA pilot cross-sectional study
01. Dezember 2006
Accepted after resubmission 08. Februar 2007
24. November 2017 (online)
Several in-vivo studies have shown a procoagulant state in both overt and subclinical hyperthyroidism and in subclinical hypothyroidism. Insofar, no clinical studies have ever evaluated the relationship between thyroid dysfunction and clinically deep venous thrombosis (DVT). A pilot cross-sectional study aimed at assessing the frequency of overt and subclinical thyroid dysfunction patients with DVT was carried out. Fifty consecutive adult outpatients with a previous diagnosis of provoked DVT (pDVT), and 50 consecutive adult outpatients with a previous diagnosis unprovoked DVT (unDVT),both of the lower legs,who were followed at the Thrombosis Unit of the University Hospital of Varese, Italy, were enrolled after written informed consent. Fifty subjects, in whom such a diagnosis could be ruled out, served as controls. In each patient serum free thyroxine (FT4), free triiodothyronine (FT3), thyrotropin (TSH), anti-thyroid peroxidase (AbTPO), and anti-thyroglobulin (AbTg) antibodies were assayed. Previously unrecognised subclinical hypothyroidism was diagnosed in seven (14.0%) unDVT patients, one (2%) pDVT patient, and one (2%) control (odds ratio at multivariate analysis, 5.54; 95% confidence interval, 0.6–52.6); one new case of subclinical hyperthyroidism was diagnosed in each group; only one case (in the control group) of clinical overt hyperthyroidism was observed. The prevalence of thyroid autoantibodies, including both euthyroid and subclinical hypothyroid patients, did not differ in the three groups.The results of this pilot study suggest an increased prevalence of subclinical hypothyroidism in patients with unDVT.The clinical relevance of these preliminary findings needs to be addressed in larger prospective studies.
- 1 Squizzato A, Gerdes VE, Brandjes DP. et al. Thyroid diseases and cerebrovascular disease. Stroke 2005; 36: 2302-2310.
- 2 Marongiu F, Cauli C, Mariotti S. Thyroid, hemostasis and thrombosis. J Endocrinol Invest 2004; 27: 1065-1071.
- 3 Shih CH, Chen SL, Yen CC, Huang YH, Chen CD, Lee YS. et al. Thyroid hormone receptor dependent transcriptional regulation of fibrinogen and coagulation proteins. Endocrinology 2004; 145: 2804-2814.
- 4 Cappola AR, Ladenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 2003; 02: 438-444.
- 5 Chadaverian R, Bruckert E, Ankri A. et al. Relationship between thyroid hormones and plasma D-dimer levels. Thromb Haemost 1998; 79: 99-103.
- 6 Chadaverian R, Bruckert E, Leenhardt L. et al. Components of the fibrinolytic system are differently altered in moderate and severe hypothyroidism. J Clin Endocrinol Metab 2001; 86: 732-737.
- 7 Erem C, Ersoz H, Karti SS. et al. Blood coagulation and fibrinolysis in hyperthyroidism. J Endocrinol Invest 2002; 25: 345-350.
- 8 Franchini M. Hemostasis and thyroid diseases revisited. J Endocrinol Invest 2004; 27: 886-892.
- 9 Hofbauer LC, Heufelder AE. Coagulation disorders in thyroid diseases. Eur J Endocrinol 1997; 136: 1-7.
- 10 Muller B, Tsakiris DA, Roth CB. et al. Haemostatic profile in hypothyroidism as potential risk for vascular or thrombotic disease. Eur J Clin Invest 2001; 31: 131-137.
- 11 Roberts CGP, Ladenson PW. Hypothyroidism. Lancet 2004; 363: 793-803.
- 12 Cooper DS. Hyperthyroidism. Lancet 2003; 362: 459-468.
- 13 Surks MI, Ortiz E, Daniels GH. et al. Subclinical thyroid disease. Scientific review and guidelines for diagnosis and management. J Am Med Assoc 2004; 291: 228-238.
- 14 Marongiu F, Conti M, Mameli G. et al. Fibrinogen and fibrinolytic activity in hyperthyroidism before and after antithyroid treatment. J Endocrinol Invest 1988; 11: 723-725.