Title: Variation of Certain Haemostatic Parameters in Hypothyroidism

Author: Dr Lanke Vani

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.162

Abstract

Thyroid disorders which has increased incidence in females, were found to effect coagulation- fibrinolytic system. In the present study an effort is made to evaluate the alterations of certain haemostatic parameters in overt hypothyroid patients.

Bleeding time, clotting time & platelet count were estimated in hypothyroid subjects and control group, with sample size of 15 each. Hypothyroid group included subjects with low FT3, FT4 & elevated TSH value (mean 14.9 mU/L).Both the groups were age and sex matched. The results showed prolonged bleeding time and clotting time which were statistically significant with p-value of <0.0001 for both the parameters each. In the present study, hypothyroid group showed decreased platelet count when compared to control group which was statistically significant with a p-value of <0.0001.This finding was in contrast to many of the previous studies which showed either increase in platelet count or even if there was decrease, it was statistically not so significant.

This shows increased bleeding tendency or hypocoagulable state in overt hypothyroid patients. The more elevated the TSH levels, the more the deviation of haemostatic parameters from normal.

Key-words: Hypothyroidism FT3, FT4, TSH, haemostasis, bleeding time, clotting time, platelet count

References

  1. Goldsmith, R.E., Sturgis, S.H., Lerman, J. & Stanbury, J.B.The menstrual pattern in thyroid disease. J Clin Endocrinol Metab 1952, 12: 846-855.
  2. Scott, J.C. & Mussey, E. Menstrual patterns in myxedema.Am J Obstet Gynecol 1964, 90: 161-165.
  3. Longcope, C. The male and female reproductive systems. In:Ingbar, S.H. & Braverman, L.E. (eds) The Thyroid, 5th J.B. Lippincott, Philadelphia, 1986, pp. 1194-1199.
  4. Stern, B. & Altschule, M.D. Hematological studies in hypothyroidism following total thyroidectomy. J Clin Invest1936, 15: 633-641.
  5. Sjoberg, R.J., Kidd, G.S., Swanson, E. et al. Thromboxane and prostacyclin generation in hypothyroidism. Clin Res 1984, 32: 690A.
  6. Edson, J.R., Fecher, D.R. & Doe, R.P. Low platelet adhesiveness and other hemostatic abnormalities in hypothyroidism. Ann Intern Med 1975, 82: 342-346.
  7. Hellem, A.J., Segaard, E. & Solem, J.H. The adhesiveness of human blood platelets and thyroid function. Acta Med Scand 1975, 197: 15-17.
  8. Gardikas, C., Arapakis, G. & Dervenagas, S. The effect of certain hormones on platelet aggregation in vitro. Acta Haematol 1972, 47: 297-302.
  9. O'Regan, S. & Fong, J.S.C. Platelet hyperaggregability in hypothyroid rats.  Proc Soc Exp Biol Med 1978, 158:575-577.
  10. Nordoy, A., Vik-mo, H. & Berntsen, H. Haemostatic and lipid abnormalities in hypothyroidism. Scand J Haematol 1976, 16: 154-160.
  11. Valdemarsson, S., Fagher, B., Hedner, P., Monti, M. &Nilsson-Ehle, P. Platelet and adipocyte thermogenesis in hypothyroid patients: a microcalorimetric study. Acta Endocrinol 1985, 108: 361-366.
  12. Sjoberg, R.J., Kidd, G.S., Swanson, E. et al. Thromboxane and prostacyclin generation in hypothyroidism. Clin Res 1984, 32: 690A.
  13. Hymes, K., Blum, M., Lackner, H. & Karpatkin, S. Easy bruising, thrombocytopenia, and elevated platelet immunoglobulin G in Graves' disease and Hashimoto's thyroiditis.Ann Intern Med 1981, 94: 27-30.
  14. Van Doormaal, J.J., van der Meer, J., Oosten, H.R., Halie, M.R. & Doorenbos, H. Hypothyroidism leads to more small-sized platelets in circulation. Thromb Haemost 1987,58: 964-965.
  15. Jakway JL. Acquired von Willebrand’s disease. Hematology/Oncology Clinics of North America 1992 6 1409–1419.
  16. Palareti G, Biagi G, Legnani C, Bianchi D, Serra D, Savini R & Coccheri S. Association of reduced factor VIII with impaired platelet reactivity to adrenalin and collagen after total thyroidectomy. Thrombosis and Haemostasis 1989 62 1053–1056.
  17. Attivissimo LA, Lichtman SM & Klein I. Acquired von Willebrand’s syndrome causing a hemorrhagic diathesis in a patient with hypothyroidism. Thyroid 1995 5 399–401.
  18. Michiels JJ, Schroyens W, Berneman Z & van der Planken M.Acquired von Willebrand syndrome type 1 in hypothyroidism:reversal after treatment with thyroxine. Clinical and Applied Thrombosis Hemostasis 2001 7 113–115.
  19. Setian N, Tanaka CM, Damiani D, Dichtchekenian V, Carneiro JD & D’Amico EA. Hypopituitarism, deficiency of factors V and VIII and von Willebrand factor: an uncommon association. Journal of Pediatric Endocrinology and Metabolism 2002 15 331–333.
  20. Masunaga R, Nagasaka A, Nakai A, Kotake M, Sawai Y, Oda N, Mokuno T, Shimazaki K, Hayakawa N, Kato R, Hirano E,Hagiwara M & Hidaka H. Alteration of platelet aggregation in patients with thyroid disorders. Metabolism 1997 46 1128–1131.
  21. Chadarevian R, Bruckert E, Ankri A, Beucler I, Giral P & Turpin G. Relationship between thyroid hormones and plasma D-dimer levels. Thrombosis Haemostasis 1998 79 99–103.
  22. Axelrod, A.R. & Berman, L. The bone marrow in hyperthyroidism and hypothyroidism. Blood 1951, 6: 436-453.
  23. Jackson, A.S. Acute hemorrhagic purpura associated with exophthalmic goiter. JAMA 1931, 96: 38-39.
  24. Crabtree, G.R., Lee, J.C. & Cornwell, G.G. III. Autoimmune thrombocytopenia purpura and Hashimoto's thyroiditis. Ann Intern Med 1975, 83: 371-372.
  25. Ingbar, S.H. The thyroid gland. In: Wilson, J.D. & Foster,D.W. (eds) Williams Textbook ofEndocrinology, 7th edition.W.B. Saunders, Philadelphia, 1985, pp. 682-815.
  26. Tachman, M.L. & Guthrie, G.P. Jr. Hypothyroidism: diversity of presentation. Endocr Rev 1984, 5: 456-465.
  27. Dalton, R.G., Savidge, G.F., Matthews, K.B. et al. Hypothyroidism as a cause of acquired von Willebrand's disease. Lancet 1987, i: 1007-1009.
  28. Farid, N.R., Griffiths, B.L., Collins, J.R., Marshall, W.H. & Ingram, D.W. Blood coagulation and fibrinolysis in thyroid disease. Thromb Haemost 1976, 35: 415-422.
  29. Simone, J.V., Abildgaard, C.F. & Schulman, I. Blood coagulation in thyroid dysfunction. N Engl J Med 1965, 273:1057-1061.
  30. Rogers, J.S.II, Shane, S.R. & Jencks, F.S. Factor VIII activity and thyroid function. Ann Intern Med 1982, 97: 713-716.
  31. Rennie, J.A.N., Bewsher, P.D., Murchison, L.E. & Ogston,D. Coagulation and fibrinolysis in thyroid disease. Acta Haematol 1978, 58: 171-177.
  32. Crispell, K.R., Parson, W. & Hollifield, G. A study of the rate of protein synthesis before and during the administration of L-triiodothyronine to patients with myxedema and healthy volunteers using N-15 glycine. J Clin Invest 1956, 35:164-169.
  33. Loelinger, E.A., van der Esch, B., Mattern, M.J. & Hemker,H.C. The biological disappearance rate of prothrombin, Factors VII, IX and X from plasma in hypothyroidism, hyperthyroidism, and during fever. Thromb Diath Haem 1964, 10: 267-277.
  34. Shenfield, G.M. Influence of thyroid dysfunction on drug pharmacokinetics. Clin Pharmacokinet 1981, 6: 275-297.
  35. Walters, M.B. The relationship between thyroid function and anticoagulant therapy. Am J Cardiol 1963, 11: 112-114.
  36. Hume, R. Fibrinolytic activity and thyroid function. Br Med J 1965, 1: 686-688.
  37. Bennett, N.B., Ogston, C.M. & McAndrew, G.M. The thyroid and fibrinolysis. Br Med J 1967, 4: 147-148.

Corresponding Author

Dr Lanke Vani

Assistant Professor, Department of Physiology,

Guntur Medical College, Guntur, A.P India

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