Contact system activation and high thrombin generation in hyperthyroidism

Kim, Namhee; Gu, Ja Yoon; Yoo, Hyun Ju; Han, Se Eun; Kim, Young Il; Nam-Goong, Il Seong; Kim, Eun Sook; Kim, Hyun Kyung

doi:10.1530/eje-16-0835

Cited by 5 publications

(6 citation statements)

References 22 publications

(34 reference statements)

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“…However, as exogenous hyperthyroidism in healthy volunteers had no effect on any of the clot structure parameters, additional mechanisms for the effects on hemostasis observed in healthy volunteers using levothyroxine must be present. The final study demonstrated that contact system activation and abundant neutrophil extracellular trap formation occurred in the high thrombin generation state in hyperthyroidism and were correlated with FT 4 level .…”

Section: Discussion and Concluding Remarksmentioning

confidence: 82%

The influence of thyroid function on the coagulation system and its clinical consequences

Elbers

Fliers

Cannegieter

2018

Journal of Thrombosis and Haemostasis

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Several studies indicate that low plasma levels of thyroid hormone shift the hemostatic system towards a hypocoagulable and hyperfibrinolytic state, whereas high levels of thyroid hormone lead to more coagulation and less fibrinolysis. Low levels of thyroid hormone thereby seem to lead to an increased bleeding risk, whereas high levels, by contrast, increase the risk of venous thromboembolism. Hypothyroidism leads to a higher incidence of acquired von Willebrand's syndrome and with increasing levels of free thyroxine, levels of fibrinogen, factor VIII and von Willebrand factor, amongst others, increase gradually, to the extent that they may lead to symptomatic venous thromboembolism in patients with hyperthyroidism. Here, we discuss the literature on the effect of thyroid hormone on the hemostatic system and the associated risk of bleeding and venous thromboembolism. Patients with hypothyroidism are at increased risk of developing bleeding complications, which could be relevant in patients undergoing invasive procedures. Furthermore, physicians should be aware of the possibility of hyperthyroidism as an underlying risk factor for venous thromboembolism, especially in unexplained cases. Clinical studies are needed to further investigate the significance for general practice of these findings. Besides the effects of hyperthyroidism on venous thromboembolism, its effects on embolism secondary to atrial fibrillation are described.

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Section: Discussion and Concluding Remarksmentioning

confidence: 82%

The influence of thyroid function on the coagulation system and its clinical consequences

Elbers

Fliers

Cannegieter

2018

Journal of Thrombosis and Haemostasis

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“…Most coagulation abnormalities associated with thyroid disease are the result of direct effects of thyroid hormones on the synthesis of various hemostatic factors or disorders of immune function [15]. Hypercoagulable states had been reported in patients with hyperthyroidism, and patients with moderate hypothyroidism have an in-creased risk of thrombosis, as opposed to bleeding tendencies in patients with severe hypothyroidism [24][25][26]. A hypercoagulable state has also been described in patients with thyroid cancer .…”

Section: Discussionmentioning

confidence: 99%

Altered TEG Parameters Identify Hypercoagulablilty and are of Diagnosis Value for Papillary Thyroid Carcinoma Patients

Kang

Wang

et al. 2018

Exp Clin Endocrinol Diabetes

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Objective The goal of this study was to clarify the changes and clinical significance of thromboelastography (TEG) parameters in papillary thyroid carcinomas and nodular goiters. Methods 62 nodular goiter (NG) patients and 53 papillary thyroid carcinoma (PTC) patients were included. Coagulation indicators, together with a series of TEG parameters were collected and analyzed, compared with results of 61 healthy controls (HC). Correlation analysis was conducted between routine coagulation indicators and TEG parameters. ROC curves were used to evaluate the potential diagnosis value of the TEG parameters that were altered in papillary thyroid carcinoma patients. Results APTT and PT in papillary thyroid carcinoma group were statistically significant higher than that in control group (p<0.05). MPV was found to be higher in PTC than NG and healthy controls.R, K and SP levels were significantly lower in PTC group than that in HC group; Angle, CI and TPI levels were significantly higher in PTC group than that in HC group. Areas under the ROC curve of CI, TPI, and angle were 0.725, 0.714, and 0.687 for distinguishing PTC from HC, 0.662, 0.668 and 0.591 for distinguishing PTC from NG. Conclusion TEG parameters are altered and indicate hypercoagulablilty status of papillary thyroid carcinoma patients; CI, TPI, and angle could be potential diagnosis indicators for detecting papillary thyroid carcinoma.

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“…One study showed that more than 50% of ALF patients exhibit abnormal thyroid parameters, and their prognosis was worse than that of normal thyroid patients (Anastasiou et al, 2015). In addition, a study suggested that hyperthyroidism was associated with an increased risk of thrombosis, and patients with hyperthyroidism show higher levels of fibrinogen (Kim et al, 2017). Another study confirmed that VWF and fibrinogen mediate up to 10% of the association between FT4 and cardiovascular disease (Bano et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Identifying novel and overlooked biomarkers, which not only guide the diagnosis and prognosis of patients with CAD but also detect new molecular mechanisms to elucidate the pathological progress of CAD, is important due to the limited predictive power of few predictors based on genetic factors and traditional clinical risk biomarkers available for risk stratification in patients with CAD. Hyperthyroidism is linked to an increased risk of thrombus (Kim et al, 2017). Data from epidemiological studies indicate that patients with low thyroid hormone levels are at higher risk of heart failure, and the prognosis of heart failure is also worse (Vale et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Free Triiodothyronine Connected With Metabolic Changes in Patients With Coronary Artery Disease by Interacting With Other Functional Indicators

Tian

Zheng

Liu

et al. 2021

Front. Mol. Biosci.

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This study aims to evaluate the association between free triiodothyronine (FT3) and outcomes of coronary artery disease (CAD) patients, as well as to assess the predictive power of FT3 and related functional markers from the perspective of potential mechanism. A total of 5104 CAD patients with an average follow-up of three years were enrolled into our study. Multivariate Cox regression was used to evaluate the associations between FT3, FT4 (free thyroxin), FT3/FT4 and death, MACE. We developed and validated an age, biomarker, and clinical history (ABC) model based on FT3 indicators to predict the prognosis of patients with CAD. In the multivariable Cox proportional hazards model, FT3 and FT3/FT4 were independent predictors of mortality (Adjusted HR = 0.624, 95% CI = 0.486–0.801; adjusted HR = 0.011, 95% CI = 0.002–0.07, respectively). Meanwhile, emerging markers pre-brain natriuretic peptide, fibrinogen, and albumin levels are significantly associated with low FT3 (p < 0.001). The new risk death score based on biomarkers can be used to well predict the outcomes of CAD patients (C index of 0.764, 95% CI = 0.731–0.797). Overall, our findings suggest that low levels of FT3 and FT3/FT4 are independent predictors of death and MACE risk in CAD patients. Besides, the prognostic model based on FT3 provides a useful tool for the death risk stratification of CAD patients.

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Contact system activation and high thrombin generation in hyperthyroidism

Abstract: This study demonstrated that contact system activation and abundant NET formation occurred in the high thrombin generation state in hyperthyroidism and were correlated with free T4 level.

Cited by 5 publications

References 22 publications

The influence of thyroid function on the coagulation system and its clinical consequences

The influence of thyroid function on the coagulation system and its clinical consequences

Altered TEG Parameters Identify Hypercoagulablilty and are of Diagnosis Value for Papillary Thyroid Carcinoma Patients

Free Triiodothyronine Connected With Metabolic Changes in Patients With Coronary Artery Disease by Interacting With Other Functional Indicators

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