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Blood coagulation and fibrinolysis in patients with hyperthyroidism

Several papers concerning abnormalities of blood coagulation and fibrinolysis during hyperthyroidism, have been published. Increased von Willebrand Factor (vWF) activity and high fibrinogen levels have been reported. However, there is controversy concerning the presence of a hypercoagulable state in hyperthyroidism. We investigated various hemostatic parameters in 41 hyperthyroid patients and compared them to 20 euthyroid controls. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, factors V, VII, VIII, IX and X activities, vWF, antithrombin III (AT III), protein C, protein S, tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor- 1 (PAI-1), as well as common lipid variables, were measured. The relationships between serum thyroid hormones and these hemostatic parameters were examined. Compared with control subjects, fibrinogen, factor IX, vWF, AT III and PAI-1 were significantly increased in patients (p<0.05, p<0.0001, p<0.05, p<0.01 and p<0.0001; respectively), whereas factor X and t-PA were decreased (p<0.05). We showed that free T4 (FT3) levels were correlated with factor VIII activity (r=0.35, p<0.05). FT4, FT3 and TSH did not correlate with fibrinogen, vWF, AT III, t-PA, or PAI-1. AT III was inversely correlated with factor VII activity (r=−0.48, p<0.01). Protein C and S were correlated with vWF levels (r=0.58, p<0.0001; r=0.55, p<0.0001, respectively). Protein C was inversely correlated with t-PA (r=−0.39, p<0.01). There was a negative correlation between triglycerides, LDL-C and F X (r=−0.45, p<0.05; r=−64, p<0.01, respectively). Mean platelet volume (MPV) was correlated with anti-thyroid peroxidase (TPO) antibodies (in Graves’disease) and F IX activity (r=0.57, p<0.05 and r=0.39, p<0.05; respectively). We found important differences in the coagulatory /fibrinolytic parameters between the hyperthyroid patients and healthy controls. Hyperthyroid patients may experience vascular endothelial dysfunction and decreased fibrinolytic activity in blood. This endothelial activation may represent a situation with a higher thromboembolic potential.

Coagulation and fibrinolysis parameters in type 2 diabetic patients with and without diabetic vascular complications.

Objectives: To investigate the markers of endogenous coagulation/fibrinolysis and vascular endothelial cell function, and to assess the relationships between hemostatic parameters and diabetic vascular complications in type 2 diabetic patients. Materials and Methods: Coagulation and fibrinolysis parameters were measured in 92 type 2 diabetic patients (43 male, 49 female, mean age 50.1 ± 13.4 years) with (n = 44) and without (n = 48) vascular diabetic complications, and in 40 nondiabetic healthy subjects (20 male, 20 female, mean age 49.8 ± 15.1 years). Common lipid parameters were also measured. Results: The plasma levels of fibrinogen, antithrombin III (AT III), plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF) activity and prothrombin time were found to be significantly increased in the type 2 diabetic patients compared with the healthy subjects. Glycosylated hemoglobin lc was inversely correlated with plasma protein S and activated prothrombin time. Protein C and S activities were positively correlated with plasma vWF activity, and were negatively correlated with plasma t-PA levels. vWF activity was negatively correlated with plasma t-PA levels. AT III levels were positively correlated with plasma total cholesterol levels, plasma low density lipoprotein cholesterol levels, plasma triglycerides and D-dimer levels. Plasma PAI-1 levels and factor V activity in diabetic patients with microvascular complications were significantly higher than those of the diabetic patients without microvascular complications. The plasma PAI-1 and platelet count were increased in patients with diabetic retinopathy compared with the diabetic patients without retinopathy. Plasma PAI-1 levels and factor VII activity were significantly higher in the diabetic patients with nephropathy than in diabetic patients without nephropathy. Plasma concentrations of fibrinogen and PAI-1 were significantly higher in the diabetic patients with neuropathy than the diabetic patients without neuropathy. Conclusions: The data demonstrated that patients with type 2 diabetes mellitus had a hypercoagulable state and hypofibrinolysis, thereby indicating that activation of coagulation with a reduced fibrinolytic activity may contribute to the increased risk of vascular disease in type 2 diabetic patients.

Prevalence of diabetes, obesity and hypertension in a Turkish population (Trabzon city).

OBJECTIVE The objectives of this study were to determine the prevalence of diabetes mellitus in Trabzon city, Turkey, using standardized diagnostic criteria, and to evaluate associated factors. METHODS A total of 3000 eligible study subjects were selected. Of those, 2646 subjects participated in the study. Individuals aged > or =20 years were selected from their family health cards and were invited to the health station. Anthropometric and demographic data were obtained for each subject. Plasma glucose was measured by an autoanalyser. People without previously diagnosed diabetes were categorized according to WHO diagnostic criteria as follows. Diabetes: a fasting plasma glucose (FPG)> or =140 mg/dl or 2-h plasma glucose > or =200 mg/dl after a 75-g oral glucose load. RESULTS The overall prevalence of diabetes in those > or =20 years of age was 6.0% (n=160). Among diabetic subjects, 69 were newly diagnosed diabetes mellitus. Age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP) and FPG were higher in diabetic subjects than in non-diabetic subjects. The prevalence of diabetes showed significant association with increased age (P<0.0001). The overall prevalence of obesity was 19.2%. The combined prevalence of both overweight and obesity was 60.6%. The prevalence of obesity was 27.4% among women and 10.7% among men (P<0.0001). Prevalence of diabetes increased with degree of obesity (P<0.0001). The rate of obesity in diabetic subjects was 35.6%. In the study population as a whole, the prevalence of obesity increased with age, being highest in the 50-59 years age group, but lower again in the 60+ age group. Prevalence of SBP> or =140 mmHg was 12.0% and of DBP> or =90 mmHg was 8.2%.

Papillary carcinoma in a thyroglossal duct remnant with normal thyroid gland

Carcinoma in the thyroglossal duct remnant is relatively uncommon. Since the first report by Uchermann (1915), more than 150 cases of carcinoma have been reported, and the majority have been papillary thyroid carcinomas (Li Volsi et al., 1974; McNicol et al., 1988). In this report, we present a case of papillary carcinoma in the thyroglossal duct with a normal thyroid gland.

Sphenoid sinus brown tumor, a mass lesion of occipital bone and hypercalcemia: An unusual presentation of primary hyperparathyroidism

Brown tumor is a focal lesion of the bone caused by primary or, less commonly, secondary or tertiary hyperparathyroidism (HPT). While the mandible is the most frequently involved bone in the head and neck region, atypical involvement of the cranium in the area of the sphenoid sinus is exceedingly rare. In the literature, a unique case of brown tumor of the sphenoid sinus was reported in a patient with primary HPT. We present a case of sphenoid sinus and occipital bone brown tumor associated with primary HPT. A 47-yr-old woman presented a 2-yr history of headaches, dizziness, diffuse body and articular pain, fatigue, and a 6- month history of intermittent nausea and vomiting, polydipsia, and polyuria. Magnetic resonance imaging (MRI) demonstrated an expansive mass lesion in the sphenoid sinus with erosion of the sellar floor and medial wall of the right orbit, and expansion in the medulla of bone. Examination of biopsy specimens obtained from sphenoid sinus mass confirmed the diagnosis of brown tumor. The biochemical laboratory studies showed elevation of parathyroid hormone and confirmed the diagnosis of primary HPT. Excision of a parathyroid adenoma affected the metabolic status into normalizing. At the follow-up of 12 months postoperatively, the size of sphenoid sinus brown tumor decreased and the mass of occipital bone disappeared. In conclusion, this is a first report of primary HPT masquerading as a destructive fibrous sphenoid sinus brown tumor associated with a mass lesion of occipital bone and hypercalcemia in the literature.