Thyroid Diseases Are an Underestimated Risk Factor for Cerebral Venous Sinus Thrombosis

Abstract

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare disease that generally accounts for just 1% of all strokes. Of the multiple risk factors that have been identified, the most common are genetic or acquired thrombophilia and the use of oral contraceptives, while the less common include local infections and mechanical causes. Thyroid diseases have been described as rare risk factors for CVST (<2% of all cases), without exact knowledge of the underlying pathophysiology. This retrospective study aimed to re-evaluate the relevance of thyroid disease as risk factor for CVST, with particular emphasis on hyperthyroidism. Patients and Methods: Confirmed cases of CVST were (re-)evaluated in terms of risk factors including thyroid parameters. Results were compared to previous data from the International Study on CVST. Results: Between 1996 and 2016, 182 patients with confirmed CVST were treated in our hospital with a median age of 44 years and a female proportion of 74.7%. Genetic or acquired thrombophilia along with the use of oral contraceptives were found to be the most common risk factors. Thyroid diseases were present in 20.9% of CVST patients; this included patients with previous (9.9%) and current thyroid dysfunction (11%). Discussion and Conclusions: Thyroid diseases may represent a more common risk factor for CVST than previously described. This holds true even if patients with current thyroid dysfunction are purely taken into account. However, 58% of patients had more than one additional risk factor, suggesting a multifactorial hypercoagulability.

COVID-19 as a trigger of cerebral venous sinus thrombosis in a patient with autoimmune hyperthyroidism: a case report

“…Hyperthyroidism can induce a hypercoagulable and hypofibrinolytic state and has been implicated as a rare predisposing factor for CVST. Retrospective studies of CVST patients in whom thyroid parameters were available found hyperthyroidism was present in 1.9–7.1% of patients [ 3 , 4 ]. Previous meta-analyses found that high thyroid hormone levels, both in subclinical and overt hyperthyroidism, were associated with elevations in factors VIII, IX, X, Von Willebrand factor, and fibrinogen.…”

“…CVST occurs in hypercoagulable states, mostly due to multiple factors, such as inborn prothrombic conditions, oral contraceptive use, infection, and systemic disease [ 1 , 2 ]. Hyperthyroidism has been implicated as a rare risk factor for CVST, wherein previous studies found it present in 1.9–7.1% of CVST patients [ 3 , 4 ]. In COVID-19, CVST is extremely rare, estimated affecting 4.5 per 100,000 cases [ 5 ].…”

Thyroid dysfunction in cerebral venous thrombosis: a retrospective cohort study

“…To the best of our knowledge, there is only one prior systematic investigation on this topic. A recent German single-centre study on 182 patients with CVT (identified over a 20-year-period) found a frequency of current thyroid disease (at the time of CVT) of 11% and previous thyroid disease of 9.9% [ 10 ]. Although these numbers were unexpectedly high, thyroid hormone levels were not systematically investigated in that study cohort, which may have led to an underdiagnosis of subclinical thyroid dysfunction.…”

Cerebral venous sinus thrombosis caused by traumatic brain injury complicating thyroid storm: a case report and discussion

“…Due to atypical clinical manifestations, it is often easily missed or misdiagnosed. Hyperthyroidism may be one of the predisposing factors for CVST [ 2 ], but nonspecialist physicians generally have limited awareness of this condition. When a patient with hyperthyroidism is admitted to the hospital due to severe trauma, clinical interventions surrounding trauma are frequently implemented without adequate attention to hyperthyroidism, which might result in adverse consequences.…”