Hoffmann Manuela Andrea, Knoll Sarah N, Baqué Pia-Elisabeth, Rosar Florian, Scharrer Inge, Reuss Stefan, Schreckenberger Mathias
Department of Nuclear Medicine, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany.
Institute for Preventive Medicine of the German Armed Forces, 56626 Andernach, Germany.
J Clin Med. 2023 Sep 11;12(18):5905. doi: 10.3390/jcm12185905.
The intent of this prospective study aimed to identify the influence of hypothyroid metabolic status on the coagulation and fibrinolytic system and association with the acquired von Willebrand syndrome (VWS-ac). We compared 54 patients without substitution therapy after radical thyroidectomy with 58 control subjects without pathological thyroid-stimulating-hormone (TSH)-values. Patients with TSH > 17.5 mU/L over a period of >4 weeks were included. The control-collective was selected based on age and sex to match the patient-collective. The data were collected using laboratory coagulation tests and patient questionnaires; a bleeding score was determined. There were significant differences in the measurement of activated-partial-thromboplastin-time (aPTT/ = 0.009), coagulation-factor VIII ( < 0.001) and von-Willebrand-activity (VWF-ac/ = 0.004) between the patient and control groups. The patient cohort showed an increased aPTT and decreased factor VIII and VWF-ac. 29.7% of the patient-collective compared to 17.2% of the control subjects met the definition of VWS-Ac ( = 0.12). The bleeding score showed significantly more bleeding symptoms in patients with a laboratory constellation of VWS-ac (no family history; = 0.04). Our results suggest hypocoagulability in hypothyroid patients. Hypothyroidism appears to have a higher incidence of VWS-ac. The increased risk of bleeding complications in hypothyroid patients may be of relevant importance for the outcome, especially in the context of invasive interventions.
这项前瞻性研究旨在确定甲状腺功能减退代谢状态对凝血和纤溶系统的影响以及与获得性血管性血友病综合征（VWS-ac）的关联。我们将54例甲状腺全切术后未接受替代治疗的患者与58例甲状腺刺激激素（TSH）值无病理改变的对照者进行了比较。纳入TSH>17.5 mU/L持续>4周的患者。根据年龄和性别选择对照人群以匹配患者人群。通过实验室凝血试验和患者问卷收集数据；确定出血评分。患者组和对照组在活化部分凝血活酶时间（aPTT /= 0.009）、凝血因子VIII（<0.001）和血管性血友病活性（VWF-ac /= 0.004）的测量上存在显著差异。患者队列显示aPTT升高，因子VIII和VWF-ac降低。患者组中有29.7%符合VWS-Ac的定义，而对照组中这一比例为17.2%（= 0.12）。出血评分显示，实验室检查符合VWS-ac（无家族史；= 0.04）的患者出血症状明显更多。我们的结果提示甲状腺功能减退患者存在低凝状态。甲状腺功能减退似乎有较高的VWS-ac发病率。甲状腺功能减退患者出血并发症风险增加可能对预后具有重要意义，尤其是在有创干预的情况下。
