Hjelm Lundgaard Maja, Carlé Allan, Birgitte Christiansen Ulla, Sørensen Anne, Risom Kristensen Søren, Andersen Stine Linding
Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Eur Thyroid J. 2022 Jul 15;11(4). doi: 10.1530/ETJ-22-0109. Print 2022 Aug 1.
Thyroid disorders have been linked to abnormalities in the coagulation system, and a hypocoagulant state has been proposed in hypothyroidism. The assessment of thyroid function is, however, not routinely recommended as part of the assessment for coagulation disorders.
We present a 32-year-old woman who had no history of thyroid disease and who recently gave birth preterm because of severe preeclampsia and intrauterine growth restriction. Due to severe placental dysfunction, she underwent a routine biochemical assessment of the coagulation system 6 months postpartum, and a prolonged activated partial thromboplastin time (APTT) (43 s) was identified along with a low level of coagulation factor VIII (0.44 IU/mL), and a low level of von Willebrand factor (vWF) antigen (0.35 IU/mL), vWF activity (0.38 IU/mL) as well as reduced generation of thrombin. The assessment of thyroid function in the patient identified autoimmune, overt hypothyroidism with a thyroid-stimulating hormone (TSH) concentration of 139 mIU/L, low levels of the peripheral thyroid hormones (total thyroxine: 43 nmol/L, total triiodothyronine: 0.9 nmol/L), and high levels of thyroid peroxidase antibodies (296 U/mL) as well as thyroglobulin antibodies (927 U/mL).
In this case, prolonged APTT provided a diagnostic clue for the assessment of thyroid function in a young woman with a recent history of severe placental dysfunction. The identification of autoimmune, overt hypothyroidism emphasizes that measurement of TSH may be of clinical importance in cases of unexplained prolonged APTT or other biochemical signs of abnormalities in the coagulation system.
Hypothyroidism has been associated with alterations of the coagulation system suggesting a hypocoagulant state. At present, measurement of thyroid-stimulating hormone is not routinely recommended as part of the assessment for coagulation disorders.
In this case, biochemical assessment of the coagulation system was routinely performed following a pregnancy complicated by severe placental dysfunction. Overt hypothyroidism of autoimmune origin was identified secondary to prolonged activated partial thromboplastin time (APTT) postpartum along with low levels of coagulation factor VIII, von Willebrand factor, and thrombin generation. Measurement of thyroid-stimulating hormone may be considered in cases of unexplained prolonged APTT.
甲状腺疾病与凝血系统异常有关，有人提出甲状腺功能减退症患者存在低凝状态。然而，甲状腺功能评估并非凝血功能障碍评估的常规推荐项目。
我们报告一名32岁女性，既往无甲状腺疾病史，近期因重度子痫前期和胎儿生长受限而早产。由于严重的胎盘功能障碍，她在产后6个月接受了凝血系统的常规生化评估，结果发现活化部分凝血活酶时间（APTT）延长（43秒），同时凝血因子VIII水平低（0.44 IU/mL）、血管性血友病因子（vWF）抗原水平低（0.35 IU/mL）、vWF活性低（0.38 IU/mL）以及凝血酶生成减少。对该患者的甲状腺功能评估发现为自身免疫性显性甲状腺功能减退症，促甲状腺激素（TSH）浓度为139 mIU/L，外周甲状腺激素水平低（总甲状腺素：43 nmol/L，总三碘甲状腺原氨酸：0.9 nmol/L），甲状腺过氧化物酶抗体水平高（296 U/mL）以及甲状腺球蛋白抗体水平高（927 U/mL）。
在本病例中，APTT延长为一名近期有严重胎盘功能障碍病史的年轻女性的甲状腺功能评估提供了诊断线索。自身免疫性显性甲状腺功能减退症的确诊强调，在不明原因的APTT延长或凝血系统其他生化异常迹象的病例中，检测TSH可能具有临床重要性。
甲状腺功能减退症与凝血系统改变有关，提示存在低凝状态。目前，促甲状腺激素检测并非凝血功能障碍评估的常规推荐项目。
在本病例中，在一次合并严重胎盘功能障碍的妊娠后常规进行了凝血系统的生化评估。产后APTT延长以及凝血因子VIII、血管性血友病因子和凝血酶生成水平低继发确诊为自身免疫性显性甲状腺功能减退症。在不明原因的APTT延长病例中可考虑检测促甲状腺激素。
