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Tian H, Xie C, Teng B, Zeng Q, Zhao Y, Li F, Jiang C, Chen Z. The genetic effects of hormones modulated by the Pituitary-Thyroid/Adrenal/Gonadal axis on the risk of developing venous thromboembolism: a mendelian randomization study. BMC Cardiovasc Disord 2024; 24:383. [PMID: 39054435 PMCID: PMC11270940 DOI: 10.1186/s12872-024-04039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The aim of this study was to explore the genetic effects of hormones modulated through the pituitary-thyroid/adrenal/gonadal axis on the risk of developing venous thromboembolism (VTE) and to investigate the potentially causal relationships between them. METHODS A two-sample Mendelian randomization (MR) design was used. The single-nucleotide polymorphisms (SNPs) used as instrumental variables for various hormones and hormone-mediated diseases were derived from published genome-wide association studies (GWASs). Summary statistics for the risk of developing VTE (including deep venous thrombosis [DVT] and pulmonary embolism [PE]) were obtained from the UK Biobank and the FinnGen consortium. Inverse-variance weighting (IVW) was applied as the primary method to analyse causal associations. Other MR methods were used for supplementary estimates and sensitivity analysis. RESULTS A genetic predisposition to greater free thyroxine (FT4) concentrations was associated with a greater risk of developing DVT (OR = 1.0007, 95%CI [1.0001-1.0013], p = 0.0174) and VTE (OR = 1.0008, 95%CI [1.0002-1.0013], p = 0.0123). Genetically predicted hyperthyroidism was significantly associated with an increased risk of developing DVT (OR = 1.0685, 95%CI [1.0139-1.1261], p = 0.0134) and VTE (OR = 1.0740, 95%CI [1.0165-1.1348], p = 0.0110). According to the initial MR analysis, testosterone concentrations were positively associated with the risk of developing VTE (OR = 1.0038, 95%CI [1.004-1.0072], p = 0.0285). After sex stratification, estradiol concentrations were positively associated with the risk of developing DVT (OR = 1.0143, 95%CI [1.0020-1.0267], p = 0.0226) and VTE (OR = 1.0156, 95%CI [1.0029-1.0285], p = 0.0158) in females, while the significant relationship between testosterone and VTE did not persist. SHBG rs858518 was identified as the only SNP that was associated with an increased risk of developing VTE, mediated by estradiol, in females. CONCLUSIONS Genetically predicted hyperthyroidism and increased FT4 concentrations were positively associated with the risk of developing VTE. The effects of genetically predicted sex hormones on the risk of developing VTE differed between males and females. Greater genetically predicted estradiol concentrations were associated with an increased risk of developing VTE in females, while the SHBG rs858518 variant may become a potential prevention and treatment target for female VTE.
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Affiliation(s)
- Hao Tian
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 N. Youyi Street, Chongqing, 400016, China
| | - Chaozheng Xie
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Biyun Teng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 N. Youyi Street, Chongqing, 400016, China
| | - Qiu Zeng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 N. Youyi Street, Chongqing, 400016, China
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 N. Youyi Street, Chongqing, 400016, China
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 N. Youyi Street, Chongqing, 400016, China
| | - Chuli Jiang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 N. Youyi Street, Chongqing, 400016, China
| | - Zheng Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 N. Youyi Street, Chongqing, 400016, China.
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Zhang L, Li K, Yang Q, Lin Y, Geng C, Huang W, Zeng W. Associations between deep venous thrombosis and thyroid diseases: a two-sample bidirectional Mendelian randomization study. Eur J Med Res 2024; 29:327. [PMID: 38877527 PMCID: PMC11177513 DOI: 10.1186/s40001-024-01933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 06/09/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Some previous observational studies have linked deep venous thrombosis (DVT) to thyroid diseases; however, the findings were contradictory. This study aimed to investigate whether some common thyroid diseases can cause DVT using a two-sample Mendelian randomization (MR) approach. METHODS This two-sample MR study used single nucleotide polymorphisms (SNPs) identified by the FinnGen genome-wide association studies (GWAS) to be highly associated with some common thyroid diseases, including autoimmune hyperthyroidism (962 cases and 172,976 controls), subacute thyroiditis (418 cases and 187,684 controls), hypothyroidism (26,342 cases and 59,827 controls), and malignant neoplasm of the thyroid gland (989 cases and 217,803 controls. These SNPs were used as instruments. Outcome datasets for the GWAS on DVT (6,767 cases and 330,392 controls) were selected from the UK Biobank data, which was obtained from the Integrative Epidemiology Unit (IEU) open GWAS project. The inverse variance weighted (IVW), MR-Egger and weighted median methods were used to estimate the causal association between DVT and thyroid diseases. The Cochran's Q test was used to quantify the heterogeneity of the instrumental variables (IVs). MR Pleiotropy RESidual Sum and Outlier test (MR-PRESSO) was used to detect horizontal pleiotropy. When the causal relationship was significant, bidirectional MR analysis was performed to determine any reverse causal relationships between exposures and outcomes. RESULTS This MR study illustrated that autoimmune hyperthyroidism slightly increased the risk of DVT according to the IVW [odds ratio (OR) = 1.0009; p = 0.024] and weighted median methods [OR = 1.001; p = 0.028]. According to Cochran's Q test, there was no evidence of heterogeneity in IVs. Additionally, MR-PRESSO did not detect horizontal pleiotropy (p = 0.972). However, no association was observed between other thyroid diseases and DVT using the IVW, weighted median, and MR-Egger regression methods. CONCLUSIONS This study revealed that autoimmune hyperthyroidism may cause DVT; however, more evidence and larger sample sizes are required to draw more precise conclusions.
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Affiliation(s)
- Lifeng Zhang
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu, 610072, Sichuan, People's Republic of China
| | - Kaibei Li
- Disinfection Supply Center, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jin Niu District, Chengdu, 610072, Sichuan, People's Republic of China
| | - Qifan Yang
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu, 610072, Sichuan, People's Republic of China
| | - Yao Lin
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu, 610072, Sichuan, People's Republic of China
| | - Caijuan Geng
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu, 610072, Sichuan, People's Republic of China
| | - Wei Huang
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu, 610072, Sichuan, People's Republic of China
| | - Wei Zeng
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu, 610072, Sichuan, People's Republic of China.
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Raho EM, Antonioni A, Cotta Ramusino N, Jubea D, Gragnaniello D, Franceschetti P, Penitenti F, Daniele A, Zatelli MC, Naccarato M, Traluci I, Pugliatti M, Padroni M. Cerebral Venous Thrombosis during Thyrotoxicosis: Case Report and Literature Update. J Pers Med 2023; 13:1557. [PMID: 38003871 PMCID: PMC10672691 DOI: 10.3390/jpm13111557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare cause of stroke, particularly in young adults. Several known thrombophilic conditions may lead to an increased CVT risk. Interestingly, few cases in the literature have reported an association between CVT and thyrotoxicosis. Here, we describe the case of a young woman with CVT and concomitant thyrotoxicosis, without any other known prothrombotic conditions. We also performed a literature review of CVT cases and hyperthyroidism, searching for all articles published in peer-reviewed journals. We identified 39 case reports/case series concerning patients with CVT associated with thyrotoxicosis, highlighting, in most cases, the association with additional known prothrombotic factors. We then discussed the possible mechanisms by which hyperthyroidism could underlie a pro-coagulative state resulting in CVT. Thyroid disease might be a more common prothrombotic risk factor than expected in determining CVT. However, in most cases, a coexistence of multiple risk factors was observed, suggesting a multifactorial genesis of the disorder. We hope that this work may alert clinicians to consider thyrotoxicosis as a potential risk factor for CVT, even in patients who apparently have no other pro-coagulative conditions.
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Affiliation(s)
- Emanuela Maria Raho
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Annibale Antonioni
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Niccolò Cotta Ramusino
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Dina Jubea
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Daniela Gragnaniello
- Neurology Unit, Neurosciences and Rehabilitation Department, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Paola Franceschetti
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Francesco Penitenti
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Andrea Daniele
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | | | - Ilaria Traluci
- Neuroradiology Unit, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Maura Pugliatti
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Marina Padroni
- Neurology Unit, Neurosciences and Rehabilitation Department, Ferrara University Hospital, 44124 Ferrara, Italy
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Ciarambino T, Crispino P, Minervini G, Giordano M. Cerebral Sinus Vein Thrombosis and Gender: A Not Entirely Casual Relationship. Biomedicines 2023; 11:1280. [PMID: 37238951 PMCID: PMC10216036 DOI: 10.3390/biomedicines11051280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/13/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
Cerebral sinus venous thrombosis (CSVT) is a relatively rare acute disorder of cerebral circulation, but it can potentially be associated with serious sequelae and a poor prognosis. The neurological manifestations associated with it are often not adequately taken into consideration given the extreme variability and nuances of its clinical presentation and given the need for radiological methods suitable for this type of diagnosis. CSVT is usually more common in women, but so far there are little data available in the literature on sex-specific characteristics regarding this pathology. CSVT is the result of multiple conditions and is therefore to be considered a multifactorial disease where at least one risk factor is present in over 80% of cases. From the literature, we learn that congenital or acquired prothrombotic states are to be considered extremely associated with the occurrence of an acute episode of CSVT and its recurrences. It is, therefore, necessary to fully know the origins and natural history of CSVT, in order to implement the diagnostic and therapeutic pathways of these neurological manifestations. In this report, we summarize the main causes of CSVT considering the possible influence of gender, bearing in mind that most of the causes listed above are pathological conditions closely linked to the female sex.
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Affiliation(s)
- Tiziana Ciarambino
- Internal Medicine Department, Hospital of Marcianise, ASL Caserta, 81024 Caserta, Italy
| | - Pietro Crispino
- Internal Medicine Department, Hospital of Latina, ASL Latina, 04100 Latina, Italy
| | - Giovanni Minervini
- Emergency Department, Hospital of Lagonegro, AOR San Carlo, 85042 Lagonegro, Italy
| | - Mauro Giordano
- Advanced Medical and Surgical Sciences Department, University of Campania, L. Vanvitelli, 81100 Naples, Italy
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Sharma SS, Gulli G, Sharma P. Cerebral venous sinus thrombosis following ChAdOx1 nCoV-19 AstraZeneca COVID-19 vaccine. JRSM Cardiovasc Dis 2023; 12:20480040231169464. [PMID: 37077469 PMCID: PMC10107960 DOI: 10.1177/20480040231169464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 03/26/2023] [Indexed: 04/21/2023] Open
Abstract
A woman in her mid-twenties was admitted with headache, ultimately leading to a diagnosis of cerebral venous sinus thrombosis 10 days after receiving a first dose of the AstraZeneca ChAdOx1 nCoV-19 vaccine (Vaxzevria). We report this case from clinical investigations to outcomes and discuss the issues raised by it regarding the ChAdOx1 nCoV-19 vaccine.
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Affiliation(s)
- Shyam S Sharma
- Edinburgh Medical School, University of
Edinburgh, Edinburgh, UK
- Shyam S Sharma, Edinburgh Medical School,
University of Edinburgh, Edinburgh, UK.
| | - Giosue Gulli
- Department of Stroke Medicine, Ashford &
St Peter's Hospitals NHS Foundation Trust, Surry, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal
Holloway University of London (ICR2UL), London, UK
- Department of Clinical Neuroscience, Imperial
College Healthcare NHS Trust, London, UK
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Mechanisms and Management of Thyroid Disease and Atrial Fibrillation: Impact of Atrial Electrical Remodeling and Cardiac Fibrosis. Cells 2022; 11:cells11244047. [PMID: 36552815 PMCID: PMC9777224 DOI: 10.3390/cells11244047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with increased cardiovascular morbidity and mortality. The pathophysiology of AF is characterized by electrical and structural remodeling occurring in the atrial myocardium. As a source of production of various hormones such as angiotensin-2, calcitonin, and atrial natriuretic peptide, the atria are a target for endocrine regulation. Studies have shown that disorders associated with endocrine dysregulation are potential underlying causes of AF. The thyroid gland is an endocrine organ that secretes three hormones: triiodothyronine (T3), thyroxine (T4) and calcitonin. Thyroid dysregulation affects the cardiovascular system. Although there is a well-established relationship between thyroid disease (especially hyperthyroidism) and AF, the underlying biochemical mechanisms leading to atrial fibrosis and atrial arrhythmias are poorly understood in thyrotoxicosis. Various animal models and cellular studies demonstrated that thyroid hormones are involved in promoting AF substrate. This review explores the recent clinical and experimental evidence of the association between thyroid disease and AF. We highlight the current knowledge on the potential mechanisms underlying the pathophysiological impact of thyroid hormones T3 and T4 dysregulation, in the development of the atrial arrhythmogenic substrate. Finally, we review the available therapeutic strategies to treat AF in the context of thyroid disease.
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7
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Interplay between cardiovascular and thyroid dysfunctions: A review of clinical implications and management strategies. Endocr Regul 2022; 56:311-328. [DOI: 10.2478/enr-2022-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Cardiovascular diseases (CVD) and thyroid dysfunction are two of the most prevailing disorders in the world that are closely interlinked. Actions of thyroid hormones are mediated via thyroid receptors present in the myocardium and the vascular tissue. Primary mechanism that links thyroid dysfunction with CVD is the modification of cardiovascular risk factors (dyslipidemia, blood pressure, coagulation parameters, etc.) resulting in endothelial and left ventricular systolic and diastolic dysfunction.
Both overt and subclinical hyperthyroidism and hypothyroidism may cause adverse alterations in cardiac function. Hyperthyroidism gives rise to palpitation, atrial fibrillation, systolic hypertension, and heart failure, whereas hypothyroidism increases diastolic hypertension, pericardial effusion, and the risk of ischemic heart disease via altering lipid and coagulation parameters. Early recognition and treatment of thyroid dysfunction may prevent adverse cardiovascular events in patients with or without pre-existing CVD.
Certain cardiac conditions and medications can cause alterations in thyroid function that may predispose an individual to higher morbidity and mortality. In certain situations, thyroid dysfunction treatment may have cardiovascular benefits. This study deals with the interplay between cardiovascular and thyroid dysfunctions associated with clinical implications and management strategies.
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Gong S, Hong W, Wu J, Xu J, Zhao J, Zhang X, Liu Y, Yu RG. Cerebral venous sinus thrombosis caused by traumatic brain injury complicating thyroid storm: a case report and discussion. BMC Neurol 2022; 22:248. [PMID: 35794521 PMCID: PMC9261005 DOI: 10.1186/s12883-022-02777-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Cerebral venous sinus thrombosis (CVST) is an uncommon cerebrovascular disease with diverse predisposing factors. We report a case of CVST caused by a thyroid storm induced by traumatic brain injury. Case presentation A 29-year-old male patient with a history of Graves’ disease with hyperthyroidism presented to our hospital with head trauma of cerebral contusion and laceration in both frontal lobes confirmed by admission CT scan. He received mannitol to lower intracranial pressure, haemostatic therapy, and antiepileptic treatment. Eight days later, he presented with signs of thyroid storms, such as tachycardia, hyperthermia, sweating and irritation, and his thyroid function tests revealed high levels of TPO-Ab, TR-Ab, TG-Ab, FT3 and FT4. Then, he entered a deep coma. His brain CT showed a thrombosis of multiple venous sinuses, along with the opening of peripheral collateral vessels, congestive infarction with haemorrhage and brain swelling. He regained consciousness after treatment with antithyroid drugs, anticoagulants, respiratory support and a regimen of sedation/analgesia. After a half-year follow-up, most of the patient’s blocked cerebral venous sinuses had been recanalized, but there were still some sequelae, such as an impaired fine motor performance of the right hand and verbal expression defects. Conclusions CVST can be induced by thyroid storms, and trauma-related thyroid storms can develop on the basis of hyperthyroidism. The purpose of this case report is to raise clinicians’ awareness and improve their ability to diagnose CVST early in patients with traumatic brain injury complicating thyroid storms to improve the neurological prognosis among similar patients.
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Affiliation(s)
- Shurong Gong
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
| | - Wenyao Hong
- Department of Neurosurgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
| | - Jiafang Wu
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
| | - Jinqing Xu
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
| | - Jianxiang Zhao
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
| | - Xiaoguang Zhang
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
| | - Yuqing Liu
- Department of Neurosurgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
| | - Rong-Guo Yu
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China.
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Situmeang RFV, Stevano R, Sutanto R. COVID-19 as a trigger of cerebral venous sinus thrombosis in a patient with autoimmune hyperthyroidism: a case report. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:40. [PMID: 35431538 PMCID: PMC8996219 DOI: 10.1186/s41983-022-00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Cerebral venous sinus thrombosis (CVST) composes an uncommon subtype of stroke caused by thrombotic occlusion of the cerebral venous system and tends to occur in hypercoagulable states. Albeit exceedingly rare, autoimmune hyperthyroidism and COVID-19 has been implicated as rare risk factors for CVST. As both conditions are capable of inducing degrees of inflammation and hypercoagulability, we postulate that COVID-19 could trigger CVST by superimposing endotheliitis and inflammation on the hypercoagulable and hypofibrinolytic state of hyperthyroidism. Case presentation We report the case of an adult male with headache, fever, nausea, vomiting, and previously known autoimmune hyperthyroidism. Diagnostics revealed elevated inflammatory and hypercoagulability markers, free T4, low TSHs, and positive SARS-CoV-2 PCR. Neuroimaging demonstrated an acute intracerebral and subdural hemorrhage attributable to cerebral sinus thromboses. A diagnosis of CVST with associated COVID-19 and autoimmune hyperthyroidism was established, and anticoagulation therapy was initiated. Follow-up examination revealed complete symptomatic resolution and regression of thrombosis. Conclusions Clinicians should be aware that even mild COVID-19 could precipitate CVST, especially in presence of other risk factors. Further studies should be conducted to evaluate the effects of mild COVID-19 on existing prothrombic states, including autoimmune hyperthyroidism. Furthermore, a high index of suspicion towards a secondary cause must be maintained for headaches in COVID-19, as it may indicate a serious etiology, including CVST.
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Glück K, Mohrs S, Hazuchova K, Bauer N, Neiger R. Impact of radioiodine treatment on acute phase proteins in hyperthyroid cats. J Feline Med Surg 2022; 24:359-365. [PMID: 34313486 PMCID: PMC8961241 DOI: 10.1177/1098612x211024954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of radioiodine treatment (RIT) on the acute phase proteins (APPs) serum amyloid A (SAA), alpha-1-acid glycoprotein (AGP) and haptoglobin (Hp) in hyperthyroid cats. METHODS Between June 2013 and November 2014, 33 hyperthyroid cats without clinical or laboratory signs of inflammatory or neoplastic disease and a body weight >2.5 kg were enrolled. Immediately before, and 12, 36, 72 h and 6 days after RIT, serum samples were obtained for determination of APP concentrations. RESULTS Both SAA and AGP concentrations changed significantly after RIT. The concentration of AGP increased gradually after treatment with a maximum concentration at the end of the study period (median baseline 398 μg/ml; median 6 days post-RIT 562 μg/ml [P = 0.001]). A relevant >two-fold increase in AGP was seen in 8/33 (24%) cats. SAA concentration increased significantly within 12 h (baseline 9.2 μg/ml; 12 h post-RIT 22.5 μg/ml [P = 0.012]). In 7/33 (21%) cats, a clinically relevant >10-fold increase in SAA was observed. Hp concentration showed no significant change (P = 0.12). CONCLUSIONS AND RELEVANCE RIT induced a mild, mainly not clinically relevant acute phase reaction (APR). AGP and SAA were useful APPs to determine RIT-induced APR.
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Affiliation(s)
- Katharina Glück
- Department of Veterinary Clinical Sciences, Small Animal Internal Medicine, Justus-Liebig-Universität Giessen, Germany
| | - Sabrina Mohrs
- Department of Veterinary Clinical Sciences, Small Animal Internal Medicine, Justus-Liebig-Universität Giessen, Germany
| | - Katarina Hazuchova
- Department of Veterinary Clinical Sciences, Small Animal Internal Medicine, Justus-Liebig-Universität Giessen, Germany
| | - Natali Bauer
- Department of Veterinary Clinical Sciences, Small Animal Internal Medicine, Justus-Liebig-Universität Giessen, Germany
| | - Reto Neiger
- Department of Veterinary Clinical Sciences, Small Animal Internal Medicine, Justus-Liebig-Universität Giessen, Germany
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Gu Y, Meng G, Zhang Q, Liu L, Wu H, Zhang S, Wang Y, Zhang T, Wang X, Sun S, Wang X, Jia Q, Song K, Liu Q, Niu K. Association of longitudinal trends in thyroid function with incident carotid atherosclerosis in middle-aged and older euthyroid subjects: the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort study. Age Ageing 2022; 51:6514233. [PMID: 35077556 DOI: 10.1093/ageing/afab276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies have posited that an association exists between thyroid function and the heart and vasculature. It remains unclear, however, whether longitudinal trends in thyroid function contribute to the development of atherosclerosis. We conducted a cohort study to examine the association of longitudinal trends in thyroid function with incident carotid atherosclerosis (CA) in middle-aged and older euthyroid subjects. METHODS This cohort study's participants were recruited from the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study in Tianjin, China. Free triiodothyronine (FT3), thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured using chemiluminescence immunoassay. CA was assessed using carotid ultrasonography. Thyroid function and ultrasonography were assessed yearly during follow-up. Multivariable Cox proportional hazards regression models were used to assess the association between thyroid function and incident CA. RESULTS A total of 3,181 participants were enrolled in the cohort study. Within 7,762 person-years of follow-up, 944 participants developed CA, the incidence rate of CA was 122 per 1,000 person-years. The fully adjusted hazards ratios (95% confidence interval) of CA for per 1-unit increase in changes of FT3, FT4 and TSH were 1.34(1.22-1.47), 1.22(1.19-1.26) and 0.92 (0.77-1.09) (P < 0.0001, <0.0001 and = 0.32, respectively), respectively. Similar significant associations between mean levels of FT3 and FT4 and incident CA were observed. However, baseline thyroid function was not associated with incident CA. CONCLUSIONS These findings suggest that higher mean levels and higher values of changes in thyroid hormones were associated with a higher risk of incident CA in middle-aged and older euthyroid subjects.
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Pohl KR, Hobohm L, Krieg VJ, Sentler C, Rogge NI, Steimke L, Ebner M, Lerchbaumer M, Hasenfuß G, Konstantinides S, Lankeit M, Keller K. Impact of thyroid dysfunction on short-term outcomes and long-term mortality in patients with pulmonary embolism. Thromb Res 2022; 211:70-78. [DOI: 10.1016/j.thromres.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/16/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Nora RD, Nusanti S, Putera I, Sidik M, Edwar L, Koesnoe S, Rachman A, Kurniawan M, Edi Tarigan T, Yunus R, Saraswati I, Zoraida Soraya S, Pratomo T. A case of aseptic bilateral cavernous sinus thrombosis following a recent inactivated SARS-CoV-2 vaccination. Taiwan J Ophthalmol 2022; 12:334-338. [PMID: 36248079 PMCID: PMC9558469 DOI: 10.4103/tjo.tjo_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022] Open
Abstract
This case report aims to describe the first report of bilateral aseptic cavernous sinus thrombosis (CST) with a recent history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. A 50-year-old woman presented with bilateral proptosis, decreased vision, and ophthalmoplegia 16 days following CoronaVac® vaccine. The visual acuity of the left eye was 20/150, while the right eye was no light perception with a hyperemic optic nerve head. She had a history of hyperthyroidism and currently on warfarin consumption. Laboratory results depicted elevated free T4, free T3, international normalized ratio, and low protein S and C. Magnetic resonance imaging showed bilateral CST, and high-dose methylprednisolone along with fondaparinux was given. The symptoms were significantly resolved, with the visual acuity of the left eye being improved to 20/20 but not the right eye. Bilateral CST has not been previously reported following inactivated SARS-CoV-2 vaccination. The underlying systemic conditions should be taken into consideration for the possibility of the inactivated SARS-CoV-2 vaccine-related event.
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14
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Andersen SL, Nielsen KK, Kristensen SR. The interrelationship between pregnancy, venous thromboembolism, and thyroid disease: a hypothesis-generating review. Thyroid Res 2021; 14:12. [PMID: 34034778 PMCID: PMC8146627 DOI: 10.1186/s13044-021-00102-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022] Open
Abstract
Pregnancy induces physiological changes that affect the risk of thrombosis and thyroid disease. In this hypothesis-generating review, the physiological changes in the coagulation system and in thyroid function during a normal pregnancy are described, and the incidence of venous thromboembolism (VTE) and thyroid disease in and after a pregnancy are compared and discussed. Furthermore, evidence regarding the association between thyroid disease and VTE in non-pregnant individuals is scrutinized. In conclusion, a normal pregnancy entails hormonal changes, which influence the onset of VTE and thyroid disease. Current evidence suggests an association between thyroid disease and VTE in non-pregnant individuals. This review proposes the hypothesis that maternal thyroid disease associates with VTE in pregnant women and call for future research studies on this subject. If an association exists in pregnant women specifically, such findings may have clinical implications regarding strategies for thyroid function testing and potential thromboprophylaxis in selected individuals.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, 9000, Aalborg, Denmark.
| | - Kasper Krogh Nielsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, 9000, Aalborg, Denmark
| | - Søren Risom Kristensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, 9000, Aalborg, Denmark
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15
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Kato A, Matsuo Y, Miyagaki A, Endo K, Hiraoka E. Portal and Mesenteric Vein Thrombosis Associated with Hyperthyroidism. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929565. [PMID: 33819210 PMCID: PMC8039364 DOI: 10.12659/ajcr.929565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 59-year-old Final Diagnosis: Portal and mesenteric vein thrombosis Symptoms: Epigastric pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Aya Kato
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu City, Chiba, Japan
| | - Yuichiro Matsuo
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu City, Chiba, Japan
| | - Aki Miyagaki
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu City, Chiba, Japan
| | - Keita Endo
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu City, Chiba, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu City, Chiba, Japan
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16
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Links TP, van der Boom T, Zandee WT, Lefrandt JD. Cardiovascular effects of overt and subclinical hyperthyroidism: focus on differentiated thyroid cancer. Endocr Connect 2021; 10:R43-R51. [PMID: 33320106 PMCID: PMC7923041 DOI: 10.1530/ec-20-0539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/14/2020] [Indexed: 12/27/2022]
Abstract
Thyroid hormone stimulates cardiac inotropy and chronotropy via direct genomic and non-genomic mechanisms. Hyperthyroidism magnifies these effects, resulting in an increase in heart rate, ejection fraction and blood volume. Hyperthyroidism also affects thrombogenesis and this may be linked to a probable tendency toward thrombosis in patients with hyperthyroidism. Patients with hyperthyroidism are therefore at higher risk for atrial fibrillation, heart failure and cardiovascular mortality. Similarly, TSH suppressive therapy for differentiated thyroid cancer is associated with increased cardiovascular risk. In this review, we present the latest insights on the cardiac effects of thyroid suppression therapy for the treatment of thyroid cancer. Finally, we will show new clinical data on how to implement this knowledge into the clinical practice of preventive medicine.
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Affiliation(s)
- Thera P Links
- Division of Endocrinology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Correspondence should be addressed to T P Links:
| | - Trynke van der Boom
- Division of Endocrinology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wouter T Zandee
- Division of Endocrinology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joop D Lefrandt
- Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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17
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Letter to the editor regarding: "High prevalence of pro-thrombotic conditions in adult patients with moyamoya disease and moyamoya syndrome: a single center study". Acta Neurochir (Wien) 2020; 162:3139-3140. [PMID: 32888074 DOI: 10.1007/s00701-020-04562-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023]
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18
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Silverman M, Wray J, Bridwell R, Cibrario A. Thyroid Storm, Rhabdomyolysis, and Pulmonary Embolism: An Unusual Triad Case Report. Clin Pract Cases Emerg Med 2020; 4:540-543. [PMID: 33217267 PMCID: PMC7676771 DOI: 10.5811/cpcem.2020.7.47774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/16/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction: Thyroid storm is a medical emergency associated with significant mortality. Hyperthyroid states have been associated with hypercoagulability as well as rhabdomyolysis. However, the pathophysiology of this association remains under investigation.
Case Report: A 62-year-old male patient presented to the emergency department with weakness and was found to have thyroid storm with concurrent submassive pulmonary embolisms and rhabdomyolysis. To our knowledge, this is the first reported presentation of this triad.
Conclusion: This case highlights the potentially difficult diagnosis and management of thyroid storm, as well as associated life-threatening complications, including venous thromboemboli and rhabdomyolysis.
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Affiliation(s)
- Montane Silverman
- Uniformed Services University F. Edward Hebert School of Medicine, Bethesda, Maryland
| | - Jesse Wray
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Rachel Bridwell
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Amber Cibrario
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
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19
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Cui Y, Heuser K, Bauer N, Neiger R. Coagulation parameters in hyperthyroid cats before and after radioiodine treatment compared with healthy controls. J Feline Med Surg 2019; 21:1134-1140. [PMID: 30571457 PMCID: PMC10814272 DOI: 10.1177/1098612x18820145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVES The aim of the study was to describe the coagulatory state of hyperthyroid cats before and after successful radioiodine therapy (RIT) compared with healthy age-matched controls, using classical coagulation parameters and thromboelastogram (TEG) as a global assessment method. The differences in coagulation activity after RIT, depending on the thyroid hormone (normal vs low total thyroxine [T4]) state, were also evaluated. METHODS Fifteen hyperthyroid cats and 10 healthy age-matched controls were recruited. Hyperthyroid cats that remained hyperthyroid 14 days after RIT were excluded. Haematology, biochemistry, T4, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and TEG were assessed in control cats and hyperthyroid cats before and 7 and 14 days after RIT. Two weeks after successful RIT, further comparisons were made between cats with normal T4 vs those with low T4. RESULTS Fourteen days after successful RIT, 7/15 cats had normal T4 and 8/15 had low T4. Thrombocytosis was noted in 6/15 cats after treatment. Fibrinogen was significantly higher (P <0.001) and PT shorter (P <0.01) in the hyperthyroid cats compared with the healthy controls and these changes persisted after RIT. Persistent increases in fibrinogen, PT, TEG maximal amplitude and TEG clot rigidity, reflecting clot stability, after RIT primarily occurred in the cats with normal T4. TEG-K (time until preset amplitude of 20 mm is reached) and alpha (α) angle reflected impaired fibrin cross-linking ability prior to RIT, which significantly increased after therapy (P <0.05). CONCLUSIONS AND RELEVANCE Based on some of the coagulation parameters, cats with hyperthyroidism showed hypercoagulable tendencies, which were mildly increased after RIT, possibly due to transient radiation-induced thyroiditis.
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Affiliation(s)
- Yi Cui
- Department of Veterinary Clinical Sciences, Small Animal Internal Medicine, Justus-Liebig University, Giessen, Germany
| | - Katharina Heuser
- Department of Veterinary Clinical Sciences, Small Animal Internal Medicine, Justus-Liebig University, Giessen, Germany
| | - Natali Bauer
- Department of Veterinary Clinical Sciences, Small Animal Internal Medicine, Justus-Liebig University, Giessen, Germany
| | - Reto Neiger
- Small Animal Clinic Hofheim, Hofheim, Germany
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20
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Razvi S, Jabbar A, Pingitore A, Danzi S, Biondi B, Klein I, Peeters R, Zaman A, Iervasi G. Thyroid Hormones and Cardiovascular Function and Diseases. J Am Coll Cardiol 2019; 71:1781-1796. [PMID: 29673469 DOI: 10.1016/j.jacc.2018.02.045] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/26/2018] [Accepted: 02/13/2018] [Indexed: 01/13/2023]
Abstract
Thyroid hormone (TH) receptors are present in the myocardium and vascular tissue, and minor alterations in TH concentration can affect cardiovascular (CV) physiology. The potential mechanisms that link CV disease with thyroid dysfunction are endothelial dysfunction, changes in blood pressure, myocardial systolic and diastolic dysfunction, and dyslipidemia. In addition, cardiac disease itself may lead to alterations in TH concentrations (notably, low triiodothyronine syndrome) that are associated with higher morbidity and mortality. Experimental data and small clinical trials have suggested a beneficial role of TH in ameliorating CV disease. The aim of this review is to provide clinicians dealing with CV conditions with an overview of the current knowledge of TH perturbations in CV disease.
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Affiliation(s)
- Salman Razvi
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom.
| | - Avais Jabbar
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Alessandro Pingitore
- Clinical Physiology Institute, Consiglio Nazionale dele Ricerche (CNR), Pisa, Italy
| | - Sara Danzi
- Queensborough Community College, The City University of New York, Bayside, New York
| | - Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Irwin Klein
- School of Medicine, New York University, New York, New York
| | - Robin Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Azfar Zaman
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Giorgio Iervasi
- Clinical Physiology Institute, Consiglio Nazionale dele Ricerche (CNR), Pisa, Italy
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21
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Christensen DH, Veres K, Ording AG, Jørgensen JOL, Cannegieter SC, Thomsen RW, Sørensen HT. Risk of cancer in patients with thyroid disease and venous thromboembolism. Clin Epidemiol 2018; 10:907-915. [PMID: 30123003 PMCID: PMC6080866 DOI: 10.2147/clep.s158869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Risk of venous thromboembolism (VTE) is increased in patients with hypo/hyperthyroidism. It is unknown whether VTE may be a presenting symptom of occult cancer in these patients. Design Nationwide population-based cohort study based on Danish medical registry data. Methods We identified all patients diagnosed with VTE during 1978–2013 who had a previous or concurrent diagnosis of hypothyroidism (N=1481) or hyperthyroidism (N=1788). We followed them until a first-time cancer diagnosis, death, emigration, or study end, whichever came first. We calculated 1-year absolute cancer risk and standardized incidence ratios (SIRs) for cancer incidence in the study population compared with national cancer incidence in the general population. Results During the first year after a VTE diagnosis, the 1-year absolute cancer risk was 3.0% among patients with hypothyroidism and 3.9% among those with hyperthyroidism. During the first year of follow-up, SIRs for cancer in the study population compared with the general population were 1.96 (95% CI: 1.42–2.64) among patients with hypothyroidism and 2.67 (95% CI: 2.07–3.39) among those with hyperthyroidism. SIRs declined substantially after 1 year but remained increased during the remainder of the follow-up period (up to 36 years) (SIR for hypothyroidism=1.16 [95% CI: 0.97–1.39]; SIR for hyperthyroidism=1.26 [95% CI: 1.08–1.46]). Conclusion VTE may be a marker of underlying occult cancer in patients with hypothyroidism or hyperthyroidism.
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Affiliation(s)
- Diana H Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Anne G Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Jens Otto L Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
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22
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Rehman A, Husnain MG, Mushtaq K, Eledrisi MS. Cerebral venous sinus thrombosis precipitated by Graves' disease. BMJ Case Rep 2018; 2018:bcr-2017-224143. [PMID: 29866676 DOI: 10.1136/bcr-2017-224143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cerebral venous sinus thrombosis usually occurs in patients with a precipitating condition such as thrombophilic disorders, pregnancy or due to medications, such as oestrogens. Some case reports have reported the co-occurrence of cerebral venous sinus thrombosis in patients with hyperthyroidism. However, the association of cerebral venous sinus thrombosis with hyperthyroidism remains contentious. We present the case of a patient who presented with a clinical picture of cerebral venous sinus thrombosis with no obvious precipitating factor. Further investigations revealed the presence of hyperthyroidism due to Graves' disease, which was thought to be the provocative disorder for cerebral venous sinus thrombosis. We would like to draw the attention of clinicians to a possible causative association between cerebral venous sinus thrombosis and hyperthyroidism.
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Affiliation(s)
- Abdul Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Sindh, Pakistan.,Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Kamran Mushtaq
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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23
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Davis PJ, Mousa SA, Schechter GP. New Interfaces of Thyroid Hormone Actions With Blood Coagulation and Thrombosis. Clin Appl Thromb Hemost 2018; 24:1014-1019. [PMID: 29742907 PMCID: PMC6714741 DOI: 10.1177/1076029618774150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Substantial clinical evidence indicates hyperthyroidism enhances coagulation and increases the risk of thrombosis. In vitro and clinical evidence implicate multiple mechanisms for this risk. Genomic actions of thyroid hormone as 3,5,3′-triiodo-L-thyronine (T3) via a nuclear thyroid hormone receptor have been implicated, but recent evidence shows that nongenomic mechanisms initiated at the receptor for L-thyroxine (T4) on platelet integrin αvβ3 are prothrombotic. The T4-initiated mechanisms involve platelet activation and, in addition, cellular production of cytokines and chemokines such as CX3CL1 with procoagulatory activities. These procoagulant actions of T4 are particulary of note because within cells T4 is not seen to be functional, but to be only a prohormone for T3. Finally, it is also possible that thyroid hormone stimulates platelet-endothelial cell interaction involved in local thrombus generation. In this brief review, we survey mechanisms by which thyroid hormone is involved in coagulation and platelet functions. It is suggested that the threshold should be lowered for considering the possibility that clinically significant clotting may complicate hyperthyroidism. The value of routine measurement of partial thromboplastin time or circulating D-dimer in patients with hyperthyroid or in patients treated with thyrotropin-suppressing dosage of T4 requires clinical testing.
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Affiliation(s)
- Paul J Davis
- 1 Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA.,2 Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Shaker A Mousa
- 1 Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA
| | - Geraldine P Schechter
- 3 Hematology Section, Medical Service, Washington Veterans Affairs Medical Center, Washington, DC, USA.,4 Department of Medicine, George Washington University, Washington, DC, USA
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24
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Porto-mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and systematic review of the 104 cases. Obes Res Clin Pract 2018; 12:317-325. [DOI: 10.1016/j.orcp.2017.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 12/25/2022]
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25
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26
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Zaane BV, Romualdi E, Brandjes D, Gerdes V, Squizzato A, Stuijver D. The effect of hyperthyroidism on procoagulant, anticoagulant and fibrinolytic factors. Thromb Haemost 2017; 108:1077-88. [DOI: 10.1160/th12-07-0496] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 08/10/2012] [Indexed: 11/05/2022]
Abstract
SummarySeveral coagulation and fibrinolytic parameters appear to be affected by thyroid hormone excess;however, the net effect on the haemostatic system remains unclear. We aimed to update our previous review and systematically summarise and meta-analyse the data by assessing the effects of thyrotoxicosis on the coagulation and fibrinolytic system in vivo. Data sources included MEDLINE (2006–2012), EMBASE (2006–2012), and reference lists. The sources were combined with our previous search containing studies from 1980–2006. Eligible studies were all observational or experimental studies. Two investigators independently extracted data and rated study quality. Weighted mean proportion and 95% confidence intervals were calculated and pooled using a fixed and a random-effects model. A total of 29 articles consisting of 51 studies were included, as in several articles more than one study was described. We included four intervention (before and after treatment in hyperthyroid patients), five cross-sectional (hyperthyroid subjects and euthyroid controls), and four experimental (before and after use of thyroid hormone in euthyroid subjects) medium/high quality studies for meta-analysis. We found that thyrotoxicosis shifts the haemostatic balance towards a hypercoagulable and hypofibrinolytic state with a rise in factors VIII and IX, fibrinogen, von Willebrand factor, and plasminogen activator inhibitor-1. This was observed in endogenous and exogenous thyrotoxicosis, and in subclinical as well as overt hyperthyroidism. We conclude that both subclinical and overt hyperthyroidism induce a prothrombotic state, which is therefore likely to be a risk factor for venous thrombosis.
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27
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28
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Tufano A, Modesti PA. The "very rare" unusual sites venous thromboses. Intern Emerg Med 2017. [PMID: 28643210 DOI: 10.1007/s11739-017-1701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy.
| | - Pietro Amedeo Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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29
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Grewal PK, Villamar MF, Raslau FD, Dobbs MR. Pearls & Oy-sters: An uncommon initial presentation of thyrotoxicosis. Neurology 2017; 89:e61-e63. [DOI: 10.1212/wnl.0000000000004213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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30
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van der Boom T, Klein Hesselink EN, Kooistra HAM, Meijer K, van der Horst-Schrivers ANA, Lefrandt JD, Links TP. Risk factors for venous thromboembolism in patients treated for differentiated thyroid carcinoma. Endocr Relat Cancer 2017; 24:267-273. [PMID: 28476911 DOI: 10.1530/erc-17-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/03/2017] [Indexed: 11/08/2022]
Abstract
Although cancer in general is a strong risk factor for developing venous thromboembolism (VTE), the risk factors for venous thromboembolic events in patients with differentiated thyroid carcinoma (DTC) have never been assessed. This is remarkable, as several parts of the treatment comprise a hypercoagulable state that could in subgroups of DTC patients lead to an increased risk of VTE. The aim of this study was to assess which risk factors could cause DTC patients to develop VTE. We performed a nested case-control study, involving cases of DTC patients treated between 1980 and 2014 with confirmed VTE after diagnosis of DTC. Controls were defined as DTC patients without VTE. In all subjects, we collected information about thyroid cancer characteristics, treatment characteristics, traditional risk factors for VTE and additional clinical data, and we performed univariable and multivariable regression analyses. We included 28 cases and 56 controls matched for age at DTC diagnosis, sex and date of DTC diagnosis. In the univariable regression analysis, histology, distant metastases, DTC risk classification, recent surgery and other active malignancy were associated with VTE. In the multivariable analysis, distant metastases (odds ratio 7.9) and recent surgery (odds ratio 6.1) were independently associated with VTE. In conclusion, surgery and presence of distant metastases are independent risk factors for developing VTE in DTC patients. The risk factors identified in this study could be considered when making decisions regarding thromboprophylaxis for patients with thyroid cancer.
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Affiliation(s)
- Trynke van der Boom
- Department of Vascular MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen,the Netherlands
| | - Esther N Klein Hesselink
- Department of Vascular MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen,the Netherlands
| | - Hilde A M Kooistra
- Department of HematologyUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Karina Meijer
- Department of HematologyUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Joop D Lefrandt
- Department of Vascular MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen,the Netherlands
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31
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Tanabe N, Hiraoka E, Hoshino M, Deshpande GA, Sawada K, Norisue Y, Tsukuda J, Suzuki T. Progressive Ischemic Stroke due to Thyroid Storm-Associated Cerebral Venous Thrombosis. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:194-197. [PMID: 28228636 PMCID: PMC5333713 DOI: 10.12659/ajcr.902297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Female, 49 Final Diagnosis: Cerebral venous thrombosis Symptoms: Altered mental state • weakness in limbs Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic
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Affiliation(s)
- Natsumi Tanabe
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Masataka Hoshino
- Department of Internal Medicine, Funabashi General Hospital, Funabashi, Chiba, Japan
| | - Gautam A Deshpande
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - Kana Sawada
- Department of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Yasuhiro Norisue
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Jumpei Tsukuda
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Toshihiko Suzuki
- Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
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Benavides Bermúdes JM, Vivas Diaz JJ, Jaramillo Trujillo G, Bernal Torres W. Trombosis venosa profunda en un paciente con hipertiroidismo de novo. Presentación de caso. REPERTORIO DE MEDICINA Y CIRUGÍA 2017. [DOI: 10.1016/j.reper.2017.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Benavides Bermúdes JM, Vivas Diaz JJ, Jaramillo Trujillo G, Bernal Torres W. Trombosis venosa profunda en un paciente con hipertiroidismo de novo. Presentación de caso. REPERTORIO DE MEDICINA Y CIRUGÍA 2017; 26:44-49. [DOI: https:/doi.org/10.1016/j.reper.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Kim BR, Jung JH, Hahm JR, Jung J, Park HJ, Kim SK. A Case of Cerebral Venous Thrombosis in a Patient with Graves' Disease. KOSIN MEDICAL JOURNAL 2016. [DOI: 10.7180/kmj.2016.31.2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Superior sagittal sinus thrombosis is an uncommon disease, and 25% of cases are considered to be idiopathic. Hypercoagulability, local bloodstream stasis, and vessel wall abnormalities may contribute to the development of this condition. The thyrotoxic phase of Graves' disease is associated with venous thrombosis caused by hypercoagulability, which is in turn induced by increased levels of homocysteine and factor VIII and decreased fibrinolytic activity. Here, we report the case of a 39-year-old male who presented with superior sagittal sinus thrombosis and concomitant hyperthyroidism.
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Jabbar A, Pingitore A, Pearce SHS, Zaman A, Iervasi G, Razvi S. Thyroid hormones and cardiovascular disease. Nat Rev Cardiol 2016; 14:39-55. [PMID: 27811932 DOI: 10.1038/nrcardio.2016.174] [Citation(s) in RCA: 383] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Myocardial and vascular endothelial tissues have receptors for thyroid hormones and are sensitive to changes in the concentrations of circulating thyroid hormones. The importance of thyroid hormones in maintaining cardiovascular homeostasis can be deduced from clinical and experimental data showing that even subtle changes in thyroid hormone concentrations - such as those observed in subclinical hypothyroidism or hyperthyroidism, and low triiodothyronine syndrome - adversely influence the cardiovascular system. Some potential mechanisms linking the two conditions are dyslipidaemia, endothelial dysfunction, blood pressure changes, and direct effects of thyroid hormones on the myocardium. Several interventional trials showed that treatment of subclinical thyroid diseases improves cardiovascular risk factors, which implies potential benefits for reducing cardiovascular events. Over the past 2 decades, accumulating evidence supports the association between abnormal thyroid function at the time of an acute myocardial infarction (MI) and subsequent adverse cardiovascular outcomes. Furthermore, experimental studies showed that thyroid hormones can have an important therapeutic role in reducing infarct size and improving myocardial function after acute MI. In this Review, we summarize the literature on thyroid function in cardiovascular diseases, both as a risk factor as well as in the setting of cardiovascular diseases such as heart failure or acute MI, and outline the effect of thyroid hormone replacement therapy for reducing the risk of cardiovascular disease.
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Affiliation(s)
- Avais Jabbar
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK.,Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | | | - Simon H S Pearce
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK.,Department of Endocrinology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Azfar Zaman
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK.,Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Giorgio Iervasi
- Clinical Physiology Institute, CNR, Via Moruzzi 1, 56124, Pisa, Italy
| | - Salman Razvi
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK.,Gateshead Health NHS Foundation Trust, Saltwell Road South, Gateshead NE8 4YL, UK
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Kyriakakis N, Lynch J, Ajjan R, Murray RD. The effects of pituitary and thyroid disorders on haemostasis: potential clinical implications. Clin Endocrinol (Oxf) 2016; 84:473-84. [PMID: 25753252 DOI: 10.1111/cen.12767] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/09/2014] [Accepted: 03/03/2015] [Indexed: 12/22/2022]
Abstract
Disturbances of coagulation and fibrinolysis are usually multifactorial and growing evidence suggests that endocrinopathies modulate the haemostatic balance. The thrombotic alterations in endocrine disorders range from mild laboratory clotting abnormalities with little clinical significance to serious thrombotic and bleeding disorders directly related to hormonal disturbances. This literature review focuses on presenting the current data on the effects of thyroid and pituitary disorders on various parameters of the haemostatic system. With the exception of overt hypothyroidism which appears to cause a bleeding tendency, the rest of the endocrinopathies discussed in this review (subclinical hypothyroidism, hyperthyroidism, endogenous hypercortisolaemia, growth hormone deficiency, acromegaly, prolactinoma/hyperprolactinaemia and hypogonadotrophic hypogonadism) are associated with a hypercoagulable and hypofibrinolytic state, increasing the overall cardiovascular risk and thromboembolic potential in these patients. In most studies, the haemostatic abnormalities seen in endocrine disorders are usually reversible with successful treatment of the underlying condition and biochemical disease remission. High-quality studies on larger patient cohorts are needed to produce robust evidence on the effects of endocrine disorders and their therapeutic interventions on coagulation and fibrinolysis, as well as on the long-term mortality and morbidity outcomes in association with endocrine-related haemostatic imbalance. Given the rarity of some of the endocrine disorders, multicentre studies are required to achieve this target.
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Affiliation(s)
- Nikolaos Kyriakakis
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Julie Lynch
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ramzi Ajjan
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Robert D Murray
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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Virgini VS, Rodondi N, Cawthon PM, Harrison SL, Hoffman AR, Orwoll ES, Ensrud KE, Bauer DC. Subclinical Thyroid Dysfunction and Frailty Among Older Men. J Clin Endocrinol Metab 2015; 100:4524-32. [PMID: 26495751 PMCID: PMC4667157 DOI: 10.1210/jc.2015-3191] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT Both subclinical thyroid dysfunction and frailty are common among older individuals, but data on the relationship between these 2 conditions are conflicting. OBJECTIVE The purpose of this study was to assess the cross-sectional and prospective associations between subclinical thyroid dysfunction and frailty and the 5 frailty subdomains (sarcopenia, weakness, slowness, exhaustion, and low activity). SETTING AND DESIGN The Osteoporotic Fractures in Men Study is a prospective cohort study. PARTICIPANTS Men older than 65 years (n = 1455) were classified into 3 groups of thyroid status: subclinical hyperthyroidism (n = 26, 1.8%), subclinical hypothyroidism (n = 102, 7.0%), and euthyroidism (n = 1327, 91.2%). MAIN OUTCOME MEASURES Frailty was defined using a slightly modified Cardiovascular Health Study Index: men with 3 or more criteria were considered frail, men with 1 to 2 criteria were considered intermediately frail, and men with no criteria were considered robust. We assessed the cross-sectional relationship between baseline thyroid function and the 3 categories of frailty status (robust/intermediate/frail) as well as the prospective association between baseline thyroid function and subsequent frailty status and mortality after a 5-year follow-up. RESULTS At baseline, compared with euthyroid participants, men with subclinical hyperthyroidism had an increased likelihood of greater frailty status (adjusted odds ratio, 2.48; 95% confidence interval, 1.15-5.34), particularly among men aged <74 years at baseline (odds ratio for frailty, 3.63; 95% confidence interval, 1.21-10.88). After 5 years of follow-up, baseline subclinical hypothyroidism and hyperthyroidism were not consistently associated with overall frailty status or frailty components. CONCLUSION Among community-dwelling older men, subclinical hyperthyroidism, but not subclinical hypothyroidism, is associated with increased odds of prevalent but not incident frailty.
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Affiliation(s)
- Vanessa S Virgini
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Nicolas Rodondi
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Peggy M Cawthon
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Stephanie Litwack Harrison
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Andrew R Hoffman
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Eric S Orwoll
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Kristine E Ensrud
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Douglas C Bauer
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
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Mazur P, Sokołowski G, Hubalewska-Dydejczyk A, Płaczkiewicz-Jankowska E, Undas A. Prothrombotic alterations in plasma fibrin clot properties in thyroid disorders and their post-treatment modifications. Thromb Res 2014; 134:510-7. [PMID: 24962680 DOI: 10.1016/j.thromres.2014.05.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/09/2014] [Accepted: 05/30/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Available data on fibrin clot properties and fibrinolysis in hyperthyroidism and hypothyroidism are inconsistent. Our objective was to assess the impact of effective treatment of hyper- and hypothyroidism on fibrin clot characteristics. MATERIAL AND METHODS In a case-control study, ex vivo plasma fibrin clot permeability (Ks) and efficiency of fibrinolysis were assessed in 35 consecutive hyperthyroid and 35 hypothyroid subjects versus 30 controls. All measurements were performed before and after 3months of thyroid function normalizing therapy. RESULTS At baseline, hyperthyroid, but not hypothyroid, patients had lower Ks than controls (p<0.0001). Hyperthyroid and hypothyroid groups compared with controls had prolonged clot lysis time (CLT), and lower rate of D-dimer release from clots (D-Drate) (all p<0.05). The regression analysis adjusted for fibrinogen showed that in hyperthyroid patients, pre-treatment thyroid stimulating hormone (TSH) independently predicted Ks, while thrombin activatable fibrinolysis inhibitor (TAFI) antigen predicted CLT. In hypothyroid individuals a similar regression model showed that TSH independently predicts CLT. After 3months of thyroid function normalizing therapy, 32 (91.4%) hyperthyroid and 30 (85.7%) hypothyroid subjects achieved euthyroidism and had improved fibrin clot properties (all p<0.05), with normalization of Ks in hyperthyroid and lysability in hypothyroid patients. CONCLUSIONS Both hyper- and mild-to-moderate hypothyroidism are associated with prothrombotic plasma fibrin clot phenotype and restoration of euthyroidism improves clot phenotype. Abnormal fibrin clot phenotype might contribute to thromboembolic risk in thyroid disease.
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Affiliation(s)
- Piotr Mazur
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland
| | - Grzegorz Sokołowski
- Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland.
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Abstract
Thyroid disorders are common in the general population and in hospitalized patients. Thyroid disease may present first with neurological complications or else may occur concurrently in patients suffering other neurological disorders, particularly those with an autoimmune etiology. For this reason neurologists will commonly encounter patients with thyroid disease. This chapter provides an overview of the neurological complications and associations of disorders of the thyroid gland. Particular emphasis is placed on conditions such as thyrotoxic periodic paralysis and myxedema coma in which the underlying thyroid disorder may be occult leading to a first, often emergency, presentation to a neurologist. Information about clinical features, diagnosis, pathogenesis, therapy, and prognosis is provided. Emphasis is placed on those aspects most likely to be relevant to the practicing neurologist and the interested reader is directed to references to good, recent review articles for further information.
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Affiliation(s)
- Clare A Wood-Allum
- Sheffield Institute for Translational Neuroscience, University of Sheffield and Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield and Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK.
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Grine S, Charfi N, Kamoun M, Mnif F, Naceur BB, Rekik N, Mnif M, Abid M. Hyperthyroidism: A rare cause of pulmonary embolism: Report of two cases. Indian J Endocrinol Metab 2013; 17:1104-1107. [PMID: 24381893 PMCID: PMC3872694 DOI: 10.4103/2230-8210.122640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Several disorders of coagulation and fibrinolysis have been widely reported in patients with hyperthyroidism. Most reports have focused on only the venous thromboembolism risk, and few of them have studied specifically the association between hyperthyroidism and pulmonary embolism (PE). We report two cases of Graves' disease complicated by PE. The first patient is a 32 year-old man, and the second patient is a 23-year-old female. PE was suspected on the basis of pulmonary hypertension in patient one, and clinical presentation in the other patient. The first patient had also right heart failure. PE was confirmed in both patients by a lung perfusion-ventilation scan test. Thrombophilia screen revealed normal findings in the first patient and an elevation in coagulation factor VIII in the second one. Both patients received heparin, followed by oral anticoagulant therapy. In addition, they were treated with radioactive iodine resulting in partial recovery from hyperthyroidismforpatient oneand clinical euthyroidism for patient two. The former died of acute heart failure secondary to a chest infection, while the later was lost to follow-up. In conclusion, hyperthyroidism is associated with increased risk of venous thromboembolism, including PE. Potential mechanisms involved in this association include endothelial dysfunction, decreased fibrinolytic activity, and increased coagulation factors levels. Thyroid evaluation is recommended in patients with unprovoked venous thromboembolic events. Conversely, the diagnosis of venous thromboembolism should be considered in patients with hyperthyroidism, particularly if additional prothrombotic risk factors are present.
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Affiliation(s)
- Sonia Grine
- Department of Endocrinology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Nadia Charfi
- Department of Endocrinology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Mahdi Kamoun
- Department of Endocrinology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Fatma Mnif
- Department of Endocrinology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Basma Ben Naceur
- Department of Endocrinology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Nabila Rekik
- Department of Endocrinology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Mouna Mnif
- Department of Endocrinology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Mohamed Abid
- Department of Endocrinology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
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Umezu T, Ashitani K, Toda T, Yanagawa T. A patient who experienced thyroid storm complicated by rhabdomyolysis, deep vein thrombosis, and a silent pulmonary embolism: a case report. BMC Res Notes 2013; 6:198. [PMID: 23687997 PMCID: PMC3669617 DOI: 10.1186/1756-0500-6-198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 05/11/2013] [Indexed: 12/22/2022] Open
Abstract
Background Thyroid storm is a serious condition of thyrotoxicosis. Hyperthyroidism often presents with thrombotic events, especially at cerebral sites; however, the possible association between a lower extremity deep vein thrombosis (LEDVT) and thyroid storm has not been previously reported. We encountered a patient who developed thyroid storm, associated with rhabdomyolysis, followed by LEDVT and a small silent pulmonary embolism (PE). The case is discussed with references to the pertinent literature. Case presentation A 50-year-old woman with no past medical history was referred to our hospital because of severe diarrhea, muscle weakness in her lower limbs (manual muscle testing: MMT 3), and disturbances of consciousness. She was diagnosed as having Graves’ disease based on the presence of struma, exophthalmos, and hyperthyroidism with TSH receptor antibody positivity; we further determined that the patient was experiencing thyroid storm based on the results of the Burch-Wartofsky scoring system and a Japanese diagnostic criteria. Treatment with steroids, iodine potassium, methimazole, and propranolol was initiated. Severe watery diarrhea continued, and the laboratory data revealed hypokalemia (2.0 meq/L). On day 14, a blood analysis showed a sudden elevation in her creatinine kinase (CK) level, leading to a diagnosis of rhabdomyolysis. Thereafter, the muscle weakness in her lower limbs advanced to a degree of MMT 1. Seven days after the diagnosis of rhabdomyolysis, pitting edema began to appear in bilateral lower extremities. Contrast-enhanced CT scans revealed a LEDVT involving the left common iliac vein, bilateral femoral veins, and left popliteal vein. Furthermore, a small PE was identified. Hyperthyroidism often presents with thrombotic events, especially at cerebral sites, but few reports of PE or LEDVT have been made. Conclusion This case suggests that the occurrence of thyroid storm may be associated with a risk of LEDVT and/or PE. We suggest that DVT preventive measures are undertaken, and that a lower limb venous echo or contrast-enhanced CT examination would be considered if LEDVT is suspected.
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Franchini M. The even closer link between the thyroid and haemostasis. Thromb Haemost 2012; 109:175-6. [PMID: 23224147 DOI: 10.1160/th12-11-0804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 11/21/2012] [Indexed: 11/05/2022]
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Abstract
Subclinical thyroid diseases--subclinical hyperthyroidism and subclinical hypothyroidism--are common clinical entities that encompass mild degrees of thyroid dysfunction. The clinical significance of mild thyroid overactivity and underactivity is uncertain, which has led to controversy over the appropriateness of diagnostic testing and possible treatment. In this Seminar, we discuss the definition, epidemiology, differential diagnoses, risks of progression to overt thyroid disease, potential effects on various health outcomes, and management of subclinical hyperthyroidism and subclinical hypothyroidism. Treatment recommendations are based on the degree to which thyroid-stimulating hormone concentrations have deviated from normal and underlying comorbidities. Large-scale randomised trials are urgently needed to inform how to best care for individuals with subclinical thyroid disease.
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Affiliation(s)
- David S Cooper
- Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Atypical clinical manifestations of graves' disease: an analysis in depth. J Thyroid Res 2011; 2012:768019. [PMID: 22132347 PMCID: PMC3206356 DOI: 10.1155/2012/768019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 07/30/2011] [Accepted: 09/01/2011] [Indexed: 12/14/2022] Open
Abstract
Over the past few decades, there has been an increase in the number of reports about newly recognized (atypical or unusual) manifestations of Graves' disease (GD), that are related to various body systems. One of these manifestations is sometimes the main presenting feature of GD. Some of the atypical manifestations are specifically related to GD, while others are also similarly seen in patients with other forms of hyperthyroidism. Lack of knowledge of the association between these findings and GD may lead to delay in diagnosis, misdiagnosis, or unnecessary investigations. The atypical clinical presentations of GD include anemia, vomiting, jaundice, and right heart failure. There is one type of anemia that is not explained by any of the known etiological factors and responds well to hyperthyroidism treatment. This type of anemia resembles anemia of chronic disease and may be termed GD anemia. Other forms of anemia that are associated with GD include pernicious anemia, iron deficiency anemia of celiac disease, and autoimmune hemolytic anemia. Vomiting has been reported as a presenting feature of Graves' disease. Some cases had the typical findings of hyperthyroidism initially masked, and the vomiting did not improve until hyperthyroidism has been detected and treated. Hyperthyroidism may present with jaundice, and on the other hand, deep jaundice may develop with the onset of overt hyperthyroidism in previously compensated chronic liver disease patients. Pulmonary hypertension is reported to be associated with GD and to respond to its treatment. GD-related pulmonary hypertension may be so severe to produce isolated right-sided heart failure that is occasionally found as the presenting manifestation of GD.
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