Thyroid dysfunction in cerebral venous thrombosis: a retrospective cohort study

Abstract

Background Cerebral venous thrombosis (CVT) is a multifactorial disease with a variety of related conditions and risk factors. Thyroid dysfunction—especially hyperthyroidism—has been linked to CVT, but this is mainly based on case reports ranging back to 1913, while systematic investigations addressing this issue are lacking. Therefore, we investigated the frequency and clinical characteristics of thyroid dysfunction in a large single-center cohort of CVT patients. Methods We retrospectively identified all consecutive patients with aseptic CVT treated at our center between 2006 and 2020. Clinical information was extracted from our electronic medical documentation system. Thyroid-stimulating hormone (TSH) had been routinely measured at admission, free thyroid hormones and thyroid autoantibodies were analyzed whenever available. Results Of 120 patients with imaging-confirmed CVT, our main analysis included 107 patients (mean age 42 ± 16 years, 74% female) in whom TSH measurements were available. Nineteen patients (17.8%, 95% confidence interval 10–25%) had thyroid dysfunction. Two had newly diagnosed hyperthyroidism (1.9%, 95% confidence interval 0–4%) caused by Graves’ disease, but without typical symptoms for this condition. Seventeen patients (15.9%, 95% confidence interval 9–23%) had hypothyroidism (12 previously diagnosed with ongoing thyroid hormone replacement therapy; 5 with newly diagnosed subclinical hypothyroidism). Clinical CVT characteristics were similar comparing patients with versus without thyroid dysfunction. Conclusion We observed a remarkably high prevalence of thyroid dysfunction in CVT patients. Whether this finding reflects a causal relationship warrants further studies. Despite that, the frequent coexistence of both diseases argues for TSH screening in CVT patients.

Associations between deep venous thrombosis and thyroid diseases: A two-sample bidirectional Mendelian Randomization study

“…In 2011, a review further suggested a clear association between hypothyroidism and bleeding tendency, while hyperthyroidism appeared to increase the risk of thrombotic events, especially cerebral venous thrombosis [14] . A retrospective cohort study [15] supports this conclusion, but this study only observed a higher proportion of concurrent thyroid dysfunction in patients with cerebral venous thrombosis. The relationship between thyroid function and venous thromboembolism remains controversial.…”

Cerebral Venous Sinus Thrombosis Associated With Subclinical Hypothyroidism: A Case Report and Literature Review

“…CVST is generally associated with poor outcomes [8,9]; however, CVST cases associated with subclinical hypothyroidism, including ours, had a good outcome. Fandler-Höfler et al have described that 17 of 107 patients with CVST were diagnosed with hypothyroidism [4]. Five of 17 (Table 1, #19-23) were diagnosed with hypothyroidism after the onset of CVST, and all had subclinical hypothyroidism, suggesting an association between CVST and subclinical hypothyroidism.…”

“…Both hyperthyroidism and hypothyroidism can cause CVST and thrombophilia [7]. However, CVST caused by subclinical hypothyroidism is rare [1][2][3][4][5][6]. In this case, hypothyroidism may be involved in thrombus formation even in subclinical conditions.…”

“…Twelve of 17 (Table 1, #7-18) were diagnosed with hypothyroidism before the onset of CVST. After the diagnosis of hypothyroidism, they developed CVST despite hormone replacement therapy, leading to normal TSH, free T3, and free T4 values [4]. Therefore, the incidence of CVST is relatively high in hypothyroidism despite hormone replacement therapy and normalized hormone levels.…”

“…Thyroid dysfunction can be a cause of cerebral venous sinus thrombosis (CVST), but most studies demonstrated that CVST is associated with hyperthyroidism. However, there are also several reports of CVST related to hypothyroidism [1][2][3][4][5][6].…”