Akut ve Subakut Derin Ven Trombozu Hastalarında Tiroid Disfonksiyonu Birlikteliği

Year 2022, Volume: 32 Issue: 2, 177 - 181, 29.04.2022

Elif Coşkun Sungur , Levent Altınay , Mustafa Buyukates , Erol Aktunç

https://doi.org/10.54005/geneltip.1036264

Abstract

Amaç: Tiroid disfonksiyonu olan hastalarda koagülasyon bozuklukları, subklinik laboratuvar anormalliklerinden hayatı tehdit eden kanamalara veya trombotik olaylara kadar uzanır. Çalışmamızda, akut-subakut DVT tespit edilen hastalarda, trombofili sebebi olarak tiroid disfonksiyonu araştırılması amaçlanmıştır.

Gereç ve Yöntem: Kasım 2015 ile Haziran 2016 arasında DVT tanısı almış 30 hasta bu vaka kontrol çalışmasına dahil edilmiştir. Hastalar provoke (bilinen etiyolojisi olan, n = 13) ve provoke edilmemiş (bilinmeyen etiyolojisi olan n = 17) hastalar olarak iki gruba ayrıldı. Provoke hasta grubu edinsel risk faktörleri (yatkınlık) ve / veya genetik risk faktörleri olan hastalar olarak ayrıldı.

Bulgular: Proveke grup ve Unprovake gruplar arasında tiroit disfonksiyonu sıklığı arasında istatistiksel olarak anlamlı fark bulunamamıştır (p=0.844). DVT geçiren hastalarımızın %70’inde PAI-1 gen mutasyonuna rastlanırken, Protrombin gen mutasyonu hastaların hiçbirinde tespit edilememiştir. Provake eden faktörler arasında en sık erkek cinsiyet ve 3 ay içinde majör cerrahi geçirmiş olma bulunmuştur.

Sonuç: Çalışmamızda akut-subakut DVT teşhis edilen hastalar ile tiroit disfonksiyonu birlikteliği arasında net bir ilişki bulunamamıştır. Bu nedenle 'provokatif faktörlerin' tiroid disfonksiyonu ile venöz tromboembolizm (VTE) ilişkisini destekleyebileceğini düşünüyoruz.Bu konuda prospektif ve daha geniş kohortlu çalışmaların yapılması gerektiğini düşünüyoruz.

Keywords

derin ven trombozu, tiroid disfonksiyonu, trombofili

Thyroid dysfunction coexistence in patients with acute and subacute deep vein thrombosis

Abstract

Objective: Coagulation anomalies in patients with thyroid dysfunction may vary from subclinical disorders in laboratory tests to life threatening thrombotic events or bleeding. We aimed to determine the effect of thyroid dysfunction on thrombophilia in patients with acute and subacute deep vein thrombosis (DVT).

Materials and Methods: A number of 30 patients with the diagnosis of DVT between November 2015 and June 2016 included in this case - control study. The patients divided into two groups as provoked (with known ethiology, n = 13) and unprovoked (with un-known ethiology, n = 17) patients. Provoked patients group divided as the patients with acquired risk factors (predisposition) and/or the patients with genetic risk factors.

Results: The difference of the rate of the thyroid dysfunction between the provoked and unprovoked groups was not significant (p=0.844). The PAI – 1 gene mutation was detected in 70% of the study cohort and none of the patients had prothrombin gene mutation. The most provocative factors for DVT were male gender and undergoing a major surgery in the last three months.

Conclusions: There was no correlation between acute – subacute DVT and thyroid dysfunction in this study. Therefore, we think that the ‘provocative factors’ may support the relation of thyroid dysfunction and venous thromboembolism (VTE). We think that more studies with larger cohorts and prospective should be conducted about this subject.

Keywords

deep vein thrombosis, thyroid dysfunction, thrombophilia

References

• References 1. Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet. 1999; 353(9159):1167 1173.
• 2. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107 (23 suppl 1): I4–I8.
• 3. Squizzato A, Romualdi E, Piantanida E et al. Subclinical hypothyroidism and deep venous thrombosis. A pilot cross-sectional study. Thromb Haemost. 2007; 97(5): 803-806.
• 4. Danescu LG, Badshah A, Danescu SC et al. Venous thromboembolismin patients hospitalized with thyroid dysfunction. Clin Appl Thromb/ Hemost 2009; 5: 676–680.
• 5. Lazlo H, Katalin PS, Harald J. Pulmonary thromboembolism in infant: postmortem diagnosis. Rom J Legal Med 2008; 16: 283–288.
• 6. Dekkers OM, Horvath Puho E, Cannegieter SC et al. Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population based cohort study. European Journal of Endocrinology 2017 176 1–9.
• 7. Kootte RS, Stuijver DJ, Dekkers OM et al. The incidence of venous thromboembolism in patients with overt hyperthyroidism: a retrospective multicentre cohort study. Thromb Haemost 2012; 107: 417– 22. 8. Kim DD, Chunilal S, Young S, Cutfield R. A study of venous thrombosis incidence in patients with acute hyperthyroidism. Intern Med J 2013; 43: 361–5.
• 9. Ramagopalan SV, Wotton CJ, Handel AE, Yeates D, Goldacre MJ. Risk of venous thromboembolism in people admitted to hospital with selected immune-mediated diseases: record-linkage study. BMC Med 2011; 9: 1.
• 10. Franchini M. Hemostatic changes in thyroid diseases: haemostasis and thrombosis. Hematology. 2006; 11: 203–208.
• 11. Chadarevian R, Bruckert E, Leenhardt L et al. Components of the fibrinolytic system are differently altered inmoderate and severe hypothyroidism. J Clin Endocrinol Metab. 2001; 86(2): 732-737.
• 12. Chadarevian R, Jublanc C, Bruckert E et al. Effect of levothyroixine replacement therapy on coagulation and fibrinolysis in severe hypothyroidism. J Endocrinol Invest. 2005; 28(5): 398-404.
• 13. Franchini M, Lippi G, Manzato F, Vescovi PP. Thyroid-associated autoimmune coagulation disorders. J Thromb Thrombolysis 2010; 29: 87–91.
• 14. Hoylaerts MF, Thys C, Arnout J, Vermylen J. Recurrent arterial thrombosis linked to autoimmune antibodies enhancing von Willebrand factor binding to platelets and inducing Fc gamma RII receptor-mediated platelet activation. Blood 1998(91); 2810–2817.
• 15. Huang G, Wang P, Li T, Deng X. Genetic association between plasminogen activator inhibitor-1 rs1799889 polymorphism and venous thromboembolism: Evidence from a comprehensive meta-analysis. Clinical Cardiology. 2019;42: 1232–1238.
• 16. Hoffbrand AV, Higgs DR, Keeling DM, Mehta AB. Postgraduate Haematology. Hoboken, NJ, USA: John Wiley & Sons; 2016.
• 17. Yılmaz S, Gunaydın S. Inherited risk factors in low-risk venous thromboembolism in patients under 45 years. Interactive Cardiovascular and Thoracic Surgery. 2015; 20 (1): 21–23.