Death From Thyrotoxicosis

Parker, John L.; Lawson, D. H.

doi:10.1016/s0140-6736(73)92019-9

Cited by 90 publications

(32 citation statements)

References 4 publications

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“…In our previous study, we reported a hypercoagulable and hypofibrinolytic state and vascular endothelial dysfunction in hyperthyroid patients compared with euthyroid controls [1]. Thus, hyperthyroid patients display a tendency to develop thromboembolic complications, with major embolism accounting for up to 18% of deaths in patients dying from thyrotoxicosis [1,27,28]. Moreover, acute cerebral ischemia has been described in hyperthyroidism independent of thyrotoxic atrial fibrillation and cardioembolic stroke [29].…”

Section: Discussionmentioning

confidence: 96%

Increased thrombin-activatable fibrinolysis inhibitor and decreased tissue factor pathway inhibitor in patients with hyperthyroidism

Erem

Ucuncu

Yılmaz

et al. 2009

Endocr

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Various abnormalities of coagulation-fibrinolytic system have been reported in patients with thyroid dysfunction. Several studies indicate that coagulation and fibrinolytic system is disturbed in the patients with hyperthyroidism. The levels of plasma thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and tissue factor pathway inhibitor (TFPI) have been very rarely investigated in patients with hyperthyroidism. Therefore, the main purpose of this study was to evaluate the profile of coagulation and fibrinolytic parameters including TAFI and TFPI in patients with hyperthyroidism. We also investigated the relationships between serum thyroid hormones and hemostatic parameters in these patients. Thirty patients with untreated hyperthyroidism and 25 age- and sex-matched healthy controls were included in the study. Factor V (FV), protein C, protein S, TFPI, and TAFI were measured. The relationships between serum thyroid hormones and these hemostatic parameters were examined. Compared with the control subjects, TAFI Ag levels were increased significantly in patients with hyperthyroidism [mean ± SD (ranges)] [177.03 ± 20.37 (131-206%) versus 145.9 ± 23.0 (89-169%)] (P < 0.001), whereas FV [89.8 ± 21.02 (49-124%) versus 116.1 ± 31.4 (56.4-200%)], protein C [72.8 ± 46.22 (2-149%) versus 144.0 ± 26.3 (74-158%)] and protein S [60.06 ± 42.82 (9-156%) versus 151 ± 33 (76-231%)] activities and TFPI Ag levels [69.56 ± 17.63 (39-140 ng/ml) versus 87.5 ± 15.9 (64-121 ng/ml)] were decreased significantly (P < 0.001 for all of them). We did not find a significant difference between Graves' disease and toxic nodular goiter for hemostatic parameters. In patients with Graves' disease, serum-free T₃ levels were inversely correlated with TFPI Ag levels (r: -0.57, P < 0.05). In conclusion, we found some important differences in the hemostatic parameters between the patients with hyperthyroidism and healthy controls. Increased TAFI and decreased FV, protein C, protein S, and TFPI in these patients represent a potential hypercoagulable and hypofibrinolytic state, which might augment the risk for atherosclerotic and atherothrombotic complications. Thus, disturbances of the hemostatic system may contribute to the excess mortality due to cardiovascular disease seen in patients with hyperthyroidism.

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Section: Discussionmentioning

confidence: 96%

Increased thrombin-activatable fibrinolysis inhibitor and decreased tissue factor pathway inhibitor in patients with hyperthyroidism

Erem

Ucuncu

Yılmaz

et al. 2009

Endocr

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“…In a clinical study of 33 deaths in thyrotoxicosis some 15% died suddenly and unexpectedly in the absence of demonstrable myocardial infarction [28].…”

Section: Discussionmentioning

confidence: 99%

Three sudden deaths in men associated with undiagnosed chronic thyroiditis

Edston

1996

Int J Leg Med

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Three cases of sudden death associated with undiagnosed chronic thyroiditis are described. All were young or middle-aged men who were found dead, and death appeared to have occurred suddenly. Two of them had not previously experienced any serious medical problems, the third suffered from well-controlled Addison's disease. None had been investigated or treated for thyroid disease previously. Microscopically all showed a severe chronic thyroiditis with parenchymal destruction and reactive hyperplasia of the acinar epithelium. In the first case elevated triiodothyronin (T3), thyroxin (T4) and low thyroid stimulating hormone (TSH) were present, in the second case low T3 and T4 and normal TSH, and in the third an isolated elevation of T3 were found. Anti-thyroid antibodies were found in two cases. The possible causal relationship between silent chronic autoimmune thyroiditis and sudden death is discussed.

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“…Few studies have evaluated the prognosis of thyroid storm. Although the fatality rate was estimated to be as high as 10% to 30% in previous studies conducted outside of Japan, these findings may not be applicable to the current clinical setting due to significant advances in critical care medicine [6,175,176]. We used the results of a nationwide survey conducted in Japan to comment on current clinical practices in Japan [4].…”

Section: ■ Recommendation 12mentioning

confidence: 99%