Components of the Fibrinolytic System Are Differently Altered in Moderate and Severe Hypothyroidism

Components of the Fibrinolytic System Are Differently Altered in Moderate and Severe Hypothyroidism,RITA CHADAREVIAN,ERIC BRUCKERT,LAURENCE LEENHARDT,

Components of the Fibrinolytic System Are Differently Altered in Moderate and Severe Hypothyroidism   (Citations: 16)
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T4 levels are determinant of several components of the fibrinolytic system. However, relationships between hypothyroidism and alter- ation of fibrinolytic capacity are not well established, and published data remain conflicting. As the impact of hypothyroidism on both degradation and synthesis of proteins may vary according to the severity of the disease, we measured fibrinolytic activity across vary- ing states of hypothyroidism. We measured fibrinogen, D-dimers (DDI), a2-antiplasmin activity, tissue plasminogen activator antigen (t-PA Ag), plasminogen, plasminogen activator inhibitor antigen (PAI-1 Ag), and factor XII (FXII) of the coagulation. We prospectively included 76 middle-aged female subjects: 25 controls, 24 patients displaying moderate hypothyroidism (TSH, 10 -50 mU/L), and 27 patients with severe hypothyroidism (TSH, .50 mU/L). Blood pres- sure, body mass index, smoking habits, total cholesterol as well as high and low density lipoprotein subfractions, triglyceride, fasting glycemia, and insulinemia were recorded. We found a different pattern of fibrinolytic abnormalities according to the severity of hypothyroidism. Compared with controls, patients with moderate hypothyroidism displayed a decreased fibrinolytic ac- tivity, as reflected by lower DDI levels, higher a2-antiplasmin activ- ities, and higher levels of t-PA and PAI-1 Ag. In sharp contrast, patients with severe hypothyroidism exhibited higher DDI levels, lower a2-antiplasmin activities, and lower t-PA and PAI-1 Ag levels. These results were not accounted for by confounding factors such as age, smoking, and components of the insulin resistance syndrome. Free T4 was significantly associated with fibrinogen, a2-antiplasmin, PAI-1 Ag, total cholesterol, and triglyceride and was negatively as- sociated with DDI. The main hypotheses underlying the mechanisms by which thyroid status may affect the fibrinolytic system remain to be established. In conclusion, patients with moderate hypothyroidism, who were consistently shown to be at high risk for cardiovascular disease, have decreased fibrinolytic activity. Subjects with severe hypothyroidism have a tendency toward increased fibrinolytic activity, and these modifications may participate to the bleeding tendency observed in such patients. (J Clin Endocrinol Metab 86: 732-737, 2001)
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