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

Erfurth, Eva Marie; Ericsson, Ulla-Brltt C.; Egervall, Karln; Lethagen, Stefan

doi:10.1111/j.1365-2265.1995.tb02645.x

Cited by 18 publications

(15 citation statements)

References 26 publications

(14 reference statements)

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“…We retrieved full copies of 28 potentially appropriate studies and four abstracts (neither manuscript nor abstract of one paper could be retrieved) [8]. After excluding five articles not meeting the prespecified inclusion criteria, a total of 23 plus four abstracts were included in the final analysis [3,9–34].…”

Section: Resultsmentioning

confidence: 99%

“…Erfurth et al. investigated the acute haemostatic effect of desmopressin (DDAVP) and the long‐term effect of thyroxine replacement therapy on the plasma concentrations of coagulation factors in 10 hypothyroid patients [34].…”

Section: Resultsmentioning

confidence: 99%

“…In addition, we report on an analysis of a further 14 articles discussing 22 in vivo studies as previously reviewed (two articles were newly retrieved) [5,[35][36][37][38][39][40][41][42][43][44][45][46][47][48].…”

Section: Resultsmentioning

confidence: 99%

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Hypothyroidism and acquired von Willebrand’s syndrome: a systematic review

et al. 2008

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Acquired von Willebrand's syndrome type I is the supposed main underlying cause of bleeding tendency in hypothyroid patients. The purpose of this systematic review was to summarize the published evidence on the association between hypothyroidism and acquired von Willebrand's syndrome. All published clinical epidemiological and interventional studies, case reports and in vitro studies that investigated the association between hypothyroidism and acquired von Willebrand's syndrome were identified by a computer-assisted search of the MEDLINE and EMBASE electronic databases. A quality assessment was performed for clinical epidemiological studies. A total of 41 papers were included. A total of 22 epidemiological in vivo studies, two in vitro studies and 47 case reports were finally analyzed. No high quality in vivo study was identified. Almost all bleeding episodes described in the case reports were mucocutaneous. von Willebrand factor (VWF) antigen value was available for 23 patients: median value 28 U/dL (range: 4-45); VWF activity was available for 24 patients: median value 28.5 U/dL (range: <3-55); factor VIII activity was available for 16 patients: median value 47 U/dL (range: 9-74). Acquired von Willebrand's syndrome may be the main factor responsible for bleeding diathesis in overt hypothyroid patients. Even if bleeding episodes are mainly mild and mucocutaneous, blood transfusion, drug administration or surgical procedure may be required.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Hypothyroidism and acquired von Willebrand’s syndrome: a systematic review

et al. 2008

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“…Acquired von Willebrand's disease is very likely to be type 1 in all cases because of a normal ratio of von Willebrand's factor antigen to ristocetin cofactor r [31]. The underlying defect could possibly be a decreased synthesis of von Willebrand factor in the absence of adequate levels of thyroxine [32], and thyroxine replacement corrects these abnormalities [31, 33]. Erfurth and group have demonstrated that desmopressin immediately reduced bleeding time, enhanced platelet adhesiveness, and significantly increased plasma concentrations of factor VIII and von Willebrand's factor and hence may be valuable for the acute treatment of bleeding or as cover for surgery in a setting of myxedema crisis or severe hypothyroidism [33].…”

Section: Clinical Featuresmentioning

confidence: 99%

Myxedema Coma: A New Look into an Old Crisis

Mathew

Misgar

Ghosh

et al. 2011

Journal of Thyroid Research

143

168

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Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive care facility. Studies have shown that replacement of thyroid hormone through ryles tube with a loading dose and maintenance therapy is as efficacious as intravenous therapy. In many countries T3 is not available and oral therapy with T4 can be used effectively without major significant difference in outcomes. Hypotension, bradycardia at presentation, need for mechanical ventilation, hypothermia unresponsive to treatment, sepsis, intake of sedative drugs, lower GCS and high APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores more than 6 are significant predictors of mortality in myxedema crisis. Early intervention in hypothyroid patients developing sepsis and other precipitating factors and ensuring continued intake of thyroid supplements may prevent mortality and morbidity associated with myxedema crisis.

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“…The underlying defect could be decreased synthesis because of lack of triiodothyronine stimulation which is a possible explanation since our patient recovered from bleeding manifestations and normalised his platelets and APTT spontaneously after treatment with levothyroxine 1. The vasopressin analogue desmopressin has been shown to be a successful drug in the acute treatment of bleeding in hypothyroidism 6. Our patient also presented with anaemia.…”

Section: Discussionmentioning

confidence: 66%

Myxoedema coma: an almost forgotten, yet still existing cause of multiorgan failure

Salomo¹,

Laursen²,

Reiter³

et al. 2014

BMJ Case Reports

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A 48-year-old man was admitted to department of emergency medicine at a tertiary referral hospital due to dizziness and fatigue. Clinical features on admission were non-pitting oedema, dry skin, very sparse hair, a hoarse voice, hypothermia (rectal temperature 28.7°C), macroglossia, sinus bradycardia and slow cerebration. Blood tests revealed severe hypothyroidism. During admission, the patient developed respiratory failure, renal failure, bleeding symptoms and diffuse colitis. The patient was treated with hydrocortisone and levothyroxine and he survived miraculously. This case describes a patient with myxoedema coma with severe hypothermia and cardiac involvement with development of multiorgan dysfunction all linked to the severe depletion of triiodothyronine.

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

Cited by 18 publications

References 26 publications

Hypothyroidism and acquired von Willebrand’s syndrome: a systematic review

Hypothyroidism and acquired von Willebrand’s syndrome: a systematic review

Myxedema Coma: A New Look into an Old Crisis

Myxoedema coma: an almost forgotten, yet still existing cause of multiorgan failure

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