Risk factors of venous thromboembolism in patients treated for differentiated thyroid carcinoma.

Boom, T. van der (Trynke) (2015) Risk factors of venous thromboembolism in patients treated for differentiated thyroid carcinoma. thesis, Medicine.

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Abstract

Introduction Differentiated thyroid carcinoma (DTC) has a relatively favourable prognosis. However, patients with DTC have an increased risk of cardiovascular mortality, compared to the normal population. Long-term exposure to thyroid hormone suppression therapy in these patients is associated with increased risk of cardiovascular disease. While cancer in general is a well-known predisposing factor for venous-thromboembolism, (subclinical) hyperthyroidism is an additional risk factor in DTC patients. Hyperthyroidism is associated with a hypercoagulable state. The aim of this study is to assess the risk factors for VTE in patients with DTC, with particular interest in a possible association with treatment modalities including induction of (subclinical) hyperthyroidism. Patients and Methods In this case-control study, 23 Subjects with DTC and VTE were compared with 46 matched controls with DTC without VTE. Subjects were matched on gender and age at the end of follow-up. End of follow-up for cases was defined as date of VTE, for controls the end of clinical follow-up. Three categories of risk factors were analysed: DTC characteristics, treatment modalities, and traditional risk factors for VTE. Logistic regression models were used to find the best model to describe the relationship between VTE and the risk factors. Results Mean age at end of follow-up (±SD) was 63.4 ± 13.4 years. In the univariate analysis, the odds of developing VTE were 3.3 (95% CI 1.2 to 9.4) times higher for those with follicular thyroid carcinoma compared to those with papillary thyroid carcinoma. Patients with distant metastases at the time of DTC diagnosis had 7.8-fold (95% CI 1.4 to 42.3) increased risk of VTE compared to patients without distant metastases. In the multivariate analysis, histology was independently associated with increased VTE risk. Immobilization had a similar odds ratio, but the confidence interval was broader. I-131 therapy was negatively associated with VTE, but the odds ratio did not reach significance. Conclusion The risk factors for venous thromboembolism in patients with differentiated thyroid carcinoma are a combination of DTC characteristics, treatment modalities and traditional risk factors for VTE. Histology and the presence of distant metastases are independent DTC related risk factors. Independent traditional risk factors for VTE are immobilization, and recent surgery or trauma. Thyroid hormone suppression therapy is not associated with an increased risk of VTE.

Item Type:	Thesis (Thesis)
Supervisor name:	Lefrandt, Dr. J.D. and Links, Prof. dr. T.P.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:53
Last Modified:	25 Jun 2020 10:53
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1398

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