Links, M.H. (2021) TSH suppression therapy in patients with thyroid cancer induces a hypercoagulable state: A study on hemostasis during different thyroid hormone-levels in patients treated for differentiated thyroid cancer. thesis, Medicine.
Full text available on request.Abstract
Introduction: Treatment of differentiated thyroid carcinoma (DTC) consists of thyroidectomy, 131I-therapy and TSH-suppression therapy (THST). During this treatment patients go from eu- to hypo- and subclinical hyperthyroidism which could affect hemostasis. While severe hypothyroidism could induce a bleeding tendency, hyperthyroidism is thrombogenic. This study aims to investigate whether changing thyroid hormone levels during the treatment of DTC have adverse effects on hemostasis. Methods: Consecutive samples of DTC patients were obtained during euthyroidism (V0), hypothyroidism (V1) and subclinical hyperthyroidism (V2/3) and hemostatic proteins, functional tests of hemostasis (a thrombin generation test and a plasma-based clot lysis test), and markers of in vivo activation of hemostasis (thrombin-antithrombin complexes [TAT], plasmin-antiplasmin complexes [PAP], and d-dimer levels) were analyzed. Results: From V0 and V1 (hypothyroidism), only factor (F)VIII and FXI minimally decreased and PAP slightly increased. Von Willebrand Factor, fibrinogen, FV, FVIII, FIX, FXI, tissue�plasminogen activator and plasminogen-activator inhibitor-1 increased between V1 and V2/3 (THST). Ex-vivo thrombin forming capacity was increased and clot-lysis time was prolonged. PAP decreased slightly, TAT and D-dimer levels remained unaltered. Conclusion: During hypothyroidism, no clear changes in hemostatic parameters occurred. During THST, more profound changes resulted in a shift towards a more hypercoagulable and hypofibrinolytic state. However, unchanged levels of TAT and D-dimer indicated no evidence of acute ongoing activation of coagulation.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Zandee, dr. W.T. and Dekker, drs. B.L. |
| Faculty: | Medical Sciences |
| Date Deposited: | 05 Jan 2022 10:45 |
| Last Modified: | 05 Jan 2022 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2937 |
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