title: Association between thyroid dysfunction and venous thromboembolism in the elderly: a prospective cohort study.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Segna
authors.affiliation: Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.|Service of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Méan
authors.affiliation: CTU Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Limacher
authors.affiliation: Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Baumgartner
authors.affiliation: Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: M R
authors.initials: MR
authors.lastname: Blum
authors.affiliation: Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
authors.forename: J-H
authors.initials: JH
authors.lastname: Beer
authors.affiliation: Division of Angiology, Bern University Hospital, Bern, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Kucher
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Righini
authors.affiliation: Cardiology, University Heart Center, University Hospital and University of Zurich, Zurich, Switzerland.
authors.forename: C M
authors.initials: CM
authors.lastname: Matter
authors.affiliation: Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Frauchiger
authors.affiliation: Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Cornuz
authors.affiliation: Division of Angiology, Basel University Hospital, Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Aschwanden
authors.affiliation: Division of Angiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Banyai
authors.affiliation: Emergency Department, Cantonal Hospital of St Gallen, St Gallen, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Osterwalder
authors.affiliation: Division of Angiology, Zurich University Hospital and University of Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Husmann
authors.affiliation: Division of Endocrinology, Diabetology, Hypertension and Nutrition, Geneva University Hospital, Geneva, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Egloff
authors.affiliation: Division of Angiology, Basel University Hospital, Basel, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Staub
authors.affiliation: University Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital, Bern, Switzerland.|Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Lämmle
authors.affiliation: University Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital, Bern, Switzerland.|Department of Clinical Research, University of Bern, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Angelillo-Scherrer
authors.affiliation: Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Aujesky
authors.affiliation: Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Rodondi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000503:physiopathology; D007037:Hypothyroidism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013923:Thromboembolism; D019851:Thrombophilia / Q000097:blood; D013927:Thrombosis / Q000503:physiopathology; D013959:Thyroid Diseases / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D013961:Thyroid Gland / Q000503:physiopathology; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D013972:Thyrotropin; D013974:Thyroxine
keywords: cohort studies; hyperthyroidism; hypothyroidism; thyroid diseases; venous thromboembolism