Haemostasis in hypothyroidism

Ford, Henry C.; Carter, J. M.

doi:10.1136/pgmj.66.774.280

Cited by 63 publications

(63 citation statements)

References 38 publications

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“…Both bleeding tendency and hypercoagulable states have been reported. Decreased and increased fibrinolytic activity in hypothyroidism has been shown in several studies [13][14][15][16]. Thrombin activatable fibrinolysis inhibitor (TAFI) is a zymogene that potently inhibits fibrinolysis [8].…”

Section: Discussionmentioning

confidence: 99%

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Elevated Thrombin Activatable Fibrinolysis Inhibitor (TAFI) Antigen Levels in Overt and Subclinical Hypothyroid Patients Were Reduced by Levothyroxine Replacement

et al. 2007

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Abstract. The influence of hypothyroidism on haemostasis is an active research area. Not only bleeding tendency but also hypercoagulable states have been reported in hypothyroid patients. Decreased and increased fibrinolytic activity in hypothyroid patients has been shown in several studies. Thrombin activatable fibrinolysis inhibitor (TAFI) is an inhibitor of fibrinolysis, which has been recently isolated from human plasma. The aim of our study was to determine plasma TAFI antigen levels in overt and subclinical hypothyroidism, and to investigate the effect of levothyroxine treatment on TAFI levels. The study was performed in age-and sex-matched 30 overt hypothyroid, 30 subclinical hypothyroid patients, and 30 healthy controls. Blood samples were obtained from patients with overt and subclinical hypothyroidism before levothyroxine replacement, and one month after achieving a euthyroid state with levothyroxine. TAFI antigen levels were measured using Enzyme-Linked ImmunoSorbent Assay kits (Affinity Biologicals; Ontario, Canada). In baseline evaluation both the overt and subclinical hypothyroid groups had higher TAFI antigen levels than control group (p<0.05). High levels of TAFI antigen were correlated with the degree of thyroid failure. After achieving euthyroid state with levothyroxine replacement, TAFI antigen levels decreased significantly in patients with overt and subclinical hypothyroidism (p<0.05). Our data suggest that there are elevated plasma levels of TAFI antigen both in overt and subclinical hypothyroidism, which may be associated with hypofibrinolysis and elevated risk of thrombosis. Normalization of thyroid state by levothyroxine replacement seems to be effective in lowering of TAFI antigen levels in hypothyroidism.

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Section: Discussionmentioning

confidence: 99%

“…Decreased clearance of some coagulation factors have been shown in hypothyroidism [13]. Increased TAFI antigen levels have been reported in patients with diabetic nephropathy [34] and in patients undergoing peritoneal dialysis [35].…”

Section: Discussionmentioning

confidence: 99%

Elevated Thrombin Activatable Fibrinolysis Inhibitor (TAFI) Antigen Levels in Overt and Subclinical Hypothyroid Patients Were Reduced by Levothyroxine Replacement

et al. 2007

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“…Most abnormalities have been attributed to decreased synthesis or activity of clotting factors, including von Willebrand factor (VWF) and factor VIII (FVIII:C), or to decreased response to adrenergic stimulation (enhanced VWF release from endothelial cells) due to thyroid hormone deficiency (1,6,7). Other authors have suggested that autoimmunity may be involved (20,21).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the respective influence of thyroid hormones and TSH on blood coagulation parameters after total thyroidectomy

Yango¹,

Alexopoulou²,

Eeckhoudt

et al. 2011

European Journal of Endocrinology

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Background: Several hemostatic abnormalities have been described in hypothyroidism, such as modification of coagulation proteins and bleeding tendency. Although thyroid hormone deficiency is considered to be responsible for these changes, the underlying mechanisms have not yet been established. Objective: To evaluate the respective influence of peripheral thyroid hormones (free thyroxine) and TSH on blood clotting by assessing coagulation parameters in patients with a history of total thyroidectomy for thyroid cancer, under three different conditions: induced hypothyroidism, euthyroid state, and following recombinant human TSH (rhTSH) administration. Methods: Coagulation parameters (platelet count, fibrinogen, international normalized ratio, prothrombin time, thrombin time, activated partial thromboplastin time (APTT), factor VIII activity ((FVIII:C), as well as von Willebrand factor antigen (VWF:Ag) and VWF activity using collagen binding assay (VWF:CBA)) were measured in patients with severe hypothyroidism following withdrawal of thyroid hormone replacement therapy, and in the same patients with euthyroidism after restoring replacement treatment (group A), and before and after administering rhTSH (group B). Results: FVIII:C, VWF:Ag, and VWF:CBA were significantly decreased (P!0.001), whereas APTT was significantly increased (P!0.001) in patients with severe hypothyroidism compared with patients in the euthyroid state. No changes in clotting parameters were observed in patients who received rhTSH therapy.Conclusion: This prospective study shows that severe short-term hypothyroidism is associated with significantly lower levels of VWF:Ag, VWF:CBA, and FVIII:C. Administration of exogenous TSH has no effect on coagulation parameters. These findings suggest that thyroid hormone deficiency is likely to be the main cause of coagulation alterations in patients with hypothyroidism.

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“…Surgery or biopsy may have to be postponed for several months until the patient has become euthyroid and the bleeding diathesis has resolved (Smith & Auger, 1987). The most frequently reported defects in haemostasis in hypothyroid patients have been prolonged bleeding time, decreased platelet adhesiveness and low plasma concentrations of FVIII and vWF (Dalton et al, 1987;Smith & Auger, 1987;Edson et al, 1975;Hellem et al, 1975;Ford & Carter, 1990).…”

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confidence: 99%

Effect of acute desmopressin and of long‐term thyroxine replacement on haemostasis in hypothyroidism

Erfurth

Ericsson

Egervall

et al. 1995

Clinical Endocrinology

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Summary OBJECTIVE Hypothyroidism can be complicated by bleeding symptoms such as easy bruising, menorrhagla and sometimes even a severe bleeding tendency with fatal outcome. Usually there is a prolonged bleeding time, or a low plasma concentration of coagulation factor VIII (FVIII) or von Willebrand factor (vWF). The aim of the present study was to investigate the acute haemostatic effect of desmopressin in hypothyroid patients. Another aim was to study the long‐term effect of thyroxine replacement on the plasma concentrations of coagulation factors and to ascertain the duration of thyroxine treatment needed to restore haemostatic function. DESIGN AND PATIENTS The effects of desmopressin, given intravenously over 10 minutes at a dosage of 0.3 μg/kg, and thyroxine treatment on haemostatic function were studied prospectively In 10 patients with hypothyroidism. RESULTS Before treatment only five of the patients manifested bleeding symptoms; one had prolonged bleeding time, and one had low plasma concentrations of vWF: Ag. Desmopressin virtually immediately reduced bleeding time, enhanced platelet adhesiveness, and significantly increased plasma concentrations of FVIII and vWF. The plasma concentrations of FVIII and vWF showed a significant increase after 4 months, whereas 7 months treatment with thyroxine was needed to reduce bleeding time significantly. CONCLUSION Our results suggest that in hypothyroid patients desmopressin may be of value for the acute treatment of bleeding or as cover for surgery.

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Haemostasis in hypothyroidism

Cited by 63 publications

References 38 publications

Elevated Thrombin Activatable Fibrinolysis Inhibitor (TAFI) Antigen Levels in Overt and Subclinical Hypothyroid Patients Were Reduced by Levothyroxine Replacement

Elevated Thrombin Activatable Fibrinolysis Inhibitor (TAFI) Antigen Levels in Overt and Subclinical Hypothyroid Patients Were Reduced by Levothyroxine Replacement

Evaluation of the respective influence of thyroid hormones and TSH on blood coagulation parameters after total thyroidectomy

Effect of acute desmopressin and of long‐term thyroxine replacement on haemostasis in hypothyroidism

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