Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland.
Thromb Haemost. 2012 Nov;108(5):973-80. doi: 10.1160/TH12-04-0275. Epub 2012 Aug 23.
The aim of this prospective study was to investigate for the first time whether levothyroxine and selenomethionine, administered alone or in combination, affect coagulation and fibrinolysis in Hashimoto's thyroiditis patients with normal thyroid function tests. A group of 155 ambulatory women with recently diagnosed and previously untreated Hashimoto's thyroiditis, of whom 149 completed the study, were randomly assigned in a double-blind fashion to six months of treatment with levothyroxine, selenomethionine, levothyroxine plus selenomethionine, or placebo. The control group included 39 matched healthy women. The prothrombin time ratio, the activated partial thromboplastin time, and plasma levels/activities of fibrinogen, factor VII, von Willebrand factor, factor X and plasminogen activator inhibitor-1 (PAI-1) were assessed at baseline and after three and six months of treatment. Compared with the healthy subjects, Hashimoto's thyroiditis patients exhibited higher plasma levels/activities of all of the parameters studied, as well as were characterised by the abnormal prothrombin time ratio and activated partial thromboplastin time. All these haemostatic disturbances were reduced or normalised by levothyroxine + selenomethionine treatment, while the effect of levothyroxine or selenomethionine was limited to fibrinogen and PAI-1, respectively. Our results demonstrate that euthyroid women with Hashimoto's thyroiditis are characterised by abnormal coagulation and fibrinolysis. Levothyroxine and selenomethionine, especially if administered together, produce a beneficial effect on haemostasis in euthyroid patients with this disorder.
本前瞻性研究旨在首次探讨左甲状腺素和硒代蛋氨酸单独或联合给药是否会影响甲状腺功能正常的桥本甲状腺炎患者的凝血和纤溶。 155 名患有新近诊断和未经治疗的桥本甲状腺炎的门诊女性患者被随机分为六组，接受左甲状腺素、硒代蛋氨酸、左甲状腺素加硒代蛋氨酸或安慰剂治疗，其中 149 名患者完成了研究。对照组包括 39 名匹配的健康女性。在基线和治疗 3 个月和 6 个月时评估凝血酶原时间比值、活化部分凝血活酶时间以及纤维蛋白原、因子 VII、血管性血友病因子、因子 X 和纤溶酶原激活物抑制剂-1 (PAI-1) 的血浆水平/活性。与健康受试者相比，桥本甲状腺炎患者的所有研究参数的血浆水平/活性均较高，且凝血酶原时间比值和活化部分凝血活酶时间异常。左甲状腺素+硒代蛋氨酸治疗可降低或纠正所有这些止血紊乱，而左甲状腺素或硒代蛋氨酸的作用分别局限于纤维蛋白原和 PAI-1。我们的研究结果表明，甲状腺功能正常的桥本甲状腺炎女性患者存在凝血和纤溶异常。左甲状腺素和硒代蛋氨酸，特别是联合给药，对这种疾病的甲状腺功能正常患者的止血具有有益作用。
