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Association between thyroid dysfunction and venous thromboembolism in the elderly: a prospective cohort study
Author(s) -
Segna D.,
Méan M.,
Limacher A.,
Baumgartner C.,
Blum M. R.,
Beer J.H.,
Kucher N.,
Righini M.,
Matter C. M.,
Frauchiger B.,
Cornuz J.,
Aschwanden M.,
Banyai M.,
Osterwalder J.,
Husmann M.,
Egloff M.,
Staub D.,
Lämmle B.,
AngelilloScherrer A.,
Aujesky D.,
Rodondi N.
Publication year - 2016
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13276
Subject(s) - medicine , subclinical infection , prospective cohort study , euthyroid , incidence (geometry) , cohort study , cohort , thyroid , gastroenterology , physics , optics
Essentials Subclinical thyroid dysfunction (SCTD) has been related to hypercoagulability. We studied its association with recurrent venous thromboembolism (rVTE). Subclinical hyperthyroidism, but not hypothyroidism, may be associated with lower rVTE risk. SCTD is not associated with mortality/differences in thrombophilic biomarkers.Summary Background Venous thromboembolism ( VTE ) and subclinical thyroid dysfunction ( SCTD ) are both common in elderly patients. SCTD has been related to a hypercoagulable state and an increased thromboembolic risk. However, prospective data on the relationship between SCTD and VTE are lacking. Objectives To investigate the relationship between SCTD and recurrent VTE ( rVTE ), all‐cause mortality, and thrombophilic biomarkers. Patients Elderly patients with VTE were studied. Methods In a prospective multicenter cohort, thyroid hormones and thrombophilic biomarkers were measured 1 year after acute VTE , as both may be influenced by acute thrombosis. We defined subclinical hypothyroidism ( SH ypo) as elevated thyroid‐stimulating hormone ( TSH ) levels (4.50–19.99 mIU L –1 ), and subclinical hyperthyroidism ( SH yper) as TSH levels of < 0.45 mIU L –1 , both with normal free thyroxine levels. Outcomes were incidence of rVTE and overall mortality during follow‐up starting after the 1‐year blood sampling. Results Of 561 participants (58% with anticoagulation), 6% had SH ypo and 5% had SH yper. After 20.8 months of mean follow‐up, 9% developed rVTE and 10% died. The rVTE incidence rate was 7.2 (95% confidence interval [ CI ] 2.7–19.2) per 100 patient‐years in SH ypo participants, 0.0 (95% CI 0.0–7.6) in SH yper participants, and 5.9 (95% CI 4.4–7.8) in euthyroid participants. In multivariate analyses, the sub‐hazard ratio for rVTE was 0.00 (95% CI 0.00–0.58) in SH yper participants and 1.50 (95% CI 0.52–4.34) in SH ypo participants as compared with euthyroid participants, without increased levels of thrombophilic biomarkers. SH yper (hazard ratio [ HR ] 0.80, 95% CI 0.23–2.81) and SH ypo ( HR 0.99, 95% CI 0.30–3.29) were not associated with mortality. Conclusion In elderly patients, SH yper may be associated with lower rVTE risks. SH ypo showed a non‐statistically significant pattern of an association with rVTE , without increased mortality or differences in thrombophilic biomarkers.