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Alteration of Hemostatic Parameters in Patients with Different Levels of Subclinical Hypothyroidism and the Effect of L-thyroxine Treatment.

Abstract Subclinical hypothyroidism (SH) is associated with hypercoagulability and hypofibrinolysis. The objective of this study was to assess the effect of L-thyroxine (L-T4) treatment and to evaluate changes in the hemostatic abnormalities of patients with varying severities of SH. We measured tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), D-dimer (DDI), fibrinogen (FIB), platelet counts (PLT), mean platelet volume (MPV), platelet distribution width (PDW), activated partial thromboplastin time (APTT), and prothrombin time (PT) in 149 female subjects. The prospective study included 54 patients in the control group, 53 patients with 4.2 μIU/mL<TSH<10 μIU/mL (mild SH), and 42 patients with TSH≥10 μIU/mL (severe SH). All patients with a TSH value of ≥10 μIU/mL were given L-T4 replacement therapy, titrated to normalize their TSH levels. There were significant differences in the triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and serum uric acid (UA) levels, and in the MPV, PDW, APTT, FIB, PAI-1, t-PA, and DDI (P<0.05) measurements among three groups. These data were further tested using the least significant difference method for multiple comparisons. Patients in the severe SH group showed higher FIB, PAI-1 and t-PA levels, lower DDI levels and shorter APTT compared with the control group, whereas the hemostatic parameters in the mild SH patients were not different compared with those of the control group. After 6 months of L-T4 treatment, a significant decrease in FIB, PAI-1 and t-PA levels and an increase in APTT and DDI were observed in the severe SH group. In conclusion, SH patients displayed a distinct pattern of alteration of hemostatic parameters that was dependent on the severity of the disease. Patients with TSH levels ≥10 μIU/mL displayed hypercoagulability, which was reversed by 6 months of L-T4 treatment.
PMID
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Primary and Secondary Hemostasis in Patients With Subclinical Hypothyroidism: Effect of Levothyroxine Treatment.

Authors

Mayor MeshTerms

Hemostasis

Keywords

L-thyroxine

Subclinical Hypothyroidism

hemostasis

hypercoagulability

Journal Title annals of clinical and laboratory science
Publication Year Start




PMID- 28249913
OWN - NLM
STAT- MEDLINE
DA  - 20170302
DCOM- 20170313
LR  - 20170313
IS  - 1550-8080 (Electronic)
IS  - 0091-7370 (Linking)
VI  - 47
IP  - 1
DP  - 2017 Jan
TI  - Alteration of Hemostatic Parameters in Patients with Different Levels of
      Subclinical Hypothyroidism and the Effect of L-thyroxine Treatment.
PG  - 29-35
AB  - Subclinical hypothyroidism (SH) is associated with hypercoagulability and
      hypofibrinolysis. The objective of this study was to assess the effect of
      L-thyroxine (L-T4) treatment and to evaluate changes in the hemostatic
      abnormalities of patients with varying severities of SH. We measured tissue
      plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), D-dimer 
      (DDI), fibrinogen (FIB), platelet counts (PLT), mean platelet volume (MPV),
      platelet distribution width (PDW), activated partial thromboplastin time (APTT), 
      and prothrombin time (PT) in 149 female subjects. The prospective study included 
      54 patients in the control group, 53 patients with 4.2 muIU/mL&lt;TSH&lt;10 muIU/mL
      (mild SH), and 42 patients with TSH&gt;/=10 muIU/mL (severe SH). All patients with a
      TSH value of &gt;/=10 muIU/mL were given L-T4 replacement therapy, titrated to
      normalize their TSH levels. There were significant differences in the
      triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol
      (LDL-C), and serum uric acid (UA) levels, and in the MPV, PDW, APTT, FIB, PAI-1, 
      t-PA, and DDI (P&lt;0.05) measurements among three groups. These data were further
      tested using the least significant difference method for multiple comparisons.
      Patients in the severe SH group showed higher FIB, PAI-1 and t-PA levels, lower
      DDI levels and shorter APTT compared with the control group, whereas the
      hemostatic parameters in the mild SH patients were not different compared with
      those of the control group. After 6 months of L-T4 treatment, a significant
      decrease in FIB, PAI-1 and t-PA levels and an increase in APTT and DDI were
      observed in the severe SH group. In conclusion, SH patients displayed a distinct 
      pattern of alteration of hemostatic parameters that was dependent on the severity
      of the disease. Patients with TSH levels &gt;/=10 muIU/mL displayed
      hypercoagulability, which was reversed by 6 months of L-T4 treatment.
CI  - (c) 2017 by the Association of Clinical Scientists, Inc.
FAU - Gao, Fang
AU  - Gao F
AD  - Second Division, Department of Endocrinology, Hebei Cangzhou Central Hospital,
      Hebei, China [email protected]
FAU - Wang, Guangya
AU  - Wang G
AD  - Second Division, Department of Endocrinology, Hebei Cangzhou Central Hospital,
      Hebei, China.
FAU - Xu, Jinxiu
AU  - Xu J
AD  - Second Division, Department of Endocrinology, Hebei Cangzhou Central Hospital,
      Hebei, China.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Ann Clin Lab Sci
JT  - Annals of clinical and laboratory science
JID - 0410247
RN  - 9002-71-5 (Thyrotropin)
RN  - Q51BO43MG4 (Thyroxine)
SB  - IM
MH  - Case-Control Studies
MH  - Female
MH  - *Hemostasis
MH  - Humans
MH  - Hypothyroidism/*blood/*drug therapy
MH  - Middle Aged
MH  - Thyrotropin/blood
MH  - Thyroxine/*therapeutic use
OTO - NOTNLM
OT  - L-thyroxine
OT  - Subclinical Hypothyroidism
OT  - hemostasis
OT  - hypercoagulability
EDAT- 2017/03/03 06:00
MHDA- 2017/03/14 06:00
CRDT- 2017/03/03 06:00
AID - 47/1/29 [pii]
PST - ppublish
SO  - Ann Clin Lab Sci. 2017 Jan;47(1):29-35.

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