Association between thyroid dysfunction and venous thromboembolism in the elderly: a prospective cohort study

D Segna; M Méan; A Limacher; C Baumgartner; M R Blum; J-H Beer; N Kucher; M Righini; C M Matter; B Frauchiger; J Cornuz; M Aschwanden; M Banyai; J Osterwalder; M Husmann; M Egloff; D Staub; B Lämmle; A Angelillo-Scherrer; D Aujesky; N Rodondi

doi:10.1111/jth.13276

Association between thyroid dysfunction and venous thromboembolism in the elderly: a prospective cohort study

J Thromb Haemost. 2016 Apr;14(4):685-94. doi: 10.1111/jth.13276. Epub 2016 Mar 23.

Authors

D Segna¹, M Méan^{1

2}, A Limacher³, C Baumgartner¹, M R Blum¹, J-H Beer⁴, N Kucher⁵, M Righini⁶, C M Matter⁷, B Frauchiger⁸, J Cornuz⁹, M Aschwanden¹⁰, M Banyai¹¹, J Osterwalder¹², M Husmann¹³, M Egloff¹⁴, D Staub¹⁰, B Lämmle^{15

16}, A Angelillo-Scherrer^{15

17}, D Aujesky¹, N Rodondi¹

Affiliations

¹ Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
² Service of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
³ CTU Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
⁴ Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
⁵ Division of Angiology, Bern University Hospital, Bern, Switzerland.
⁶ Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
⁷ Cardiology, University Heart Center, University Hospital and University of Zurich, Zurich, Switzerland.
⁸ Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld, Switzerland.
⁹ Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
¹⁰ Division of Angiology, Basel University Hospital, Basel, Switzerland.
¹¹ Division of Angiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
¹² Emergency Department, Cantonal Hospital of St Gallen, St Gallen, Switzerland.
¹³ Division of Angiology, Zurich University Hospital and University of Zurich, Zurich, Switzerland.
¹⁴ Division of Endocrinology, Diabetology, Hypertension and Nutrition, Geneva University Hospital, Geneva, Switzerland.
¹⁵ University Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital, Bern, Switzerland.
¹⁶ Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
¹⁷ Department of Clinical Research, University of Bern, Bern, Switzerland.

PMID: 26816339
DOI: 10.1111/jth.13276

Abstract

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 (SHypo) as elevated thyroid-stimulating hormone (TSH) levels (4.50-19.99 mIU L(-1) ), and subclinical hyperthyroidism (SHyper) 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 SHypo and 5% had SHyper. 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 SHypo participants, 0.0 (95% CI 0.0-7.6) in SHyper 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 SHyper participants and 1.50 (95% CI 0.52-4.34) in SHypo participants as compared with euthyroid participants, without increased levels of thrombophilic biomarkers. SHyper (hazard ratio [HR] 0.80, 95% CI 0.23-2.81) and SHypo (HR 0.99, 95% CI 0.30-3.29) were not associated with mortality.

Conclusion: In elderly patients, SHyper may be associated with lower rVTE risks. SHypo showed a non-statistically significant pattern of an association with rVTE, without increased mortality or differences in thrombophilic biomarkers.

Keywords: cohort studies; hyperthyroidism; hypothyroidism; thyroid diseases; venous thromboembolism.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Biomarkers / blood
Blood Coagulation
Female
Humans
Hyperthyroidism / physiopathology
Hypothyroidism / physiopathology
Male
Middle Aged
Prospective Studies
Risk Factors
Thromboembolism
Thrombophilia / blood
Thrombosis / physiopathology
Thyroid Diseases / complications*
Thyroid Diseases / mortality
Thyroid Diseases / physiopathology*
Thyroid Gland / physiopathology
Thyrotropin / blood
Thyroxine / blood
Treatment Outcome
Venous Thromboembolism / complications*
Venous Thromboembolism / mortality
Venous Thromboembolism / physiopathology*

Substances

Biomarkers
Thyrotropin
Thyroxine