Cited by 126Thyroid Disorders and TreatmentsBlood Coagulation and Thrombosis MechanismsBlood properties and coagulation

The influence of thyroid function on the coagulation system and its clinical consequences

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Elbers, L.P.B., Fliers, E., Cannegieter, S.C.·2018·Journal of Thrombosis and Haemostasis

Abstract

Several studies indicate that low plasma levels of thyroid hormone shift the hemostatic system towards a hypocoagulable and hyperfibrinolytic state, whereas high levels of thyroid hormone lead to more coagulation and less fibrinolysis. Low levels of thyroid hormone thereby seem to lead to an increased bleeding risk, whereas high levels, by contrast, increase the risk of venous thromboembolism. Hypothyroidism leads to a higher incidence of acquired von Willebrand's syndrome and with increasing levels of free thyroxine, levels of fibrinogen, factor VIII and von Willebrand factor, amongst others, increase gradually, to the extent that they may lead to symptomatic venous thromboembolism in patients with hyperthyroidism. Here, we discuss the literature on the effect of thyroid hormone on the hemostatic system and the associated risk of bleeding and venous thromboembolism. Patients with hypothyroidism are at increased risk of developing bleeding complications, which could be relevant in patients undergoing invasive procedures. Furthermore, physicians should be aware of the possibility of hyperthyroidism as an underlying risk factor for venous thromboembolism, especially in unexplained cases. Clinical studies are needed to further investigate the significance for general practice of these findings. Besides the effects of hyperthyroidism on venous thromboembolism, its effects on embolism secondary to atrial fibrillation are described.

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  • Excess thyroid hormone activity results in a procoagulant state, with increased VWF, FVIII, fibrinogen, and D-dimer in subclinical hyperthyroidism and elevations in fibrinogen, fibronectin, VWF, thrombomodulin, and PAI-1, with decreased t-PA in overt endogenous hyperthyroidism.

    “Excess thyroid hormone activity results in a procoagulant state, with increased VWF, FVIII, fibrinogen, and D-dimer in subclinical hyperthyroidism and elevations in fibrinogen, fibronectin, VWF, thrombomodulin, and PAI-1, with decreased t-PA in overt, endogenous hyperthyroidism”

    From Pharmacodynamic and Therapeutic Actions of Levothyroxine (2021) · cites this paper as [103]

  • Low levels of circulating thyroid hormone shift the haemostatic system to a hypocoagulable hyper-fibrinolytic state, with reduced Factors VIII, IX, and XI and von Willebrand factor that are normalised on LT4.

    “low levels of circulating thyroid hormone shift the haemostatic system to a hypocoagulable hyper-fibrinolytic state, with reduced Factors VIII, IX, and XI and von Willebrand factor (VWF) that are normalised on LT4”

    From Pharmacodynamic and Therapeutic Actions of Levothyroxine (2021) · cites this paper as [103]

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Research works printed but not linked: 2

  1. Demir T, Akinci B, Comlekci A, Karaoglu O, Ozcan MA, Yener S, Yuksel F, Secil M, Yesil S. Levothyroxine (LT4) suppression treatment for benign thyroid nodules alters coagulation. Clin Endocrinol (Oxf) 2009; 71: 446-50.
  2. Dekkers OM, Horv ath-Puh o E, Cannegieter SC, Vandenbroucke JP, Sørensen HT, Jørgensen JO. Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: A popula- tion-based cohort study. Eur J Endocrinol 2017; 176: 1-9.

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Authors
Elbers, L. P. B., Fliers, E., & Cannegieter, S. C.
Affiliations
  • Slotervaartziekenhuis (NL)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Leiden University Medical Center (NL)
Corresponding author
Elbers, L.P.B.
Venue
Journal of Thrombosis and Haemostasis
Publisher
Elsevier BV
Published
2018-04
Volume
16
Issue
4
Pages
634-645
ISSN
1538-7836 (ISSN-L)
OpenAlex
W2793622710
Cited by
123
References
70
Citations by year
2026: 5 · 2025: 20 · 2024: 23 · 2023: 19 · 2022: 22 · 2021: 20 · 2020: 10 · 2019: 4
FWCI
1.31
Type
journal article
Language
en
Open access
Locations
  • Journal of Thrombosis and Haemostasis (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Blood properties and coagulation
Keywords
thyroid function, thyroid hormones, hemostasis, coagulation, fibrinolysis, hypothyroidism, hyperthyroidism, bleeding risk, venous thromboembolism, von Willebrand factor, acquired von Willebrand syndrome, fibrinogen, factor VIII
MeSH terms
Animals, Atrial Fibrillation, Blood Coagulation, Blood Coagulation Disorders, Cardiovascular Diseases, Hemorrhage, Humans, Hyperthyroidism, Hypothyroidism, Prognosis, Risk Factors, Thyroid Gland, Thyroid Hormones, Venous Thromboembolism

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