Are there any changes in the coagulation parameters before and after the treatment in children with hypothyroidia?

Abstract

Objectives: Various coagulation and fibrinolysis disorders have been reported commonly in patients with thyroid dysfunction. Although it has been observed that bleeding time, prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count, fibrinogen, D-dimer, factor VIII, and von Willebrand factor have been investigated to examine the hemostatic profiles of patients with thyroid hormone disorders, studies on protein C, protein S, antithrombin 3 (ATIII), and homocysteine are rare. Methods: The study included 25 healthy children without any hematological conditions and with normal renal and hepatic functions, as well as 25 children with hypothyroidism between the ages of 2 and 18 who were diagnosed in Pediatric Endocrinology outpatient clinics between March 2020 and June 2021, who had not yet received medical treatment, and whose TSH≥10 and fT4 levels were low for their age (significant hypothyroidism), thyroid autoantibodies were negative. Complete blood counts, PT, aPTT, international normalized ratio (INR), fibrinogen, D-dimer, protein C, protein S, ATIII, homocysteine tests, and thyroid function tests were investigated. Age-appropriate L-thyroxine therapy was administered to hypothyroid patients for a period of 12 weeks. The differences between the coagulation parameters before and after treatment were compared once thyroid function tests had returned to normal ranges. Results: Pretreatment PT, INR, D-dimer, hemoglobin, and mean corpuscular volume (MCV) levels were found to be statistically similar between the control and study groups (p>0.05). In hypothyroid patients, PTT, fibrinogen, protein C, protein S, ATIII levels were found to be statistically significantly lower than the control group before treatment (p: 0.001). While there was no significant change in D-dimer and INR levels of the patients in the study group before and after treatment (p>0.05), there was a significant increase in PTT, fibrinogen, protein C, protein S, antithrombin 3, hemoglobin, and MCV levels (p: 0.001). There was no statistically significant difference between the groups in terms of PT, INR, D-dimer, hemoglobin, and MCV levels before treatment (p>0.05). Conclusions: There is a general decrease in anticoagulant proteins in children with hypothyroidism. It is important to closely monitor the coagulation system and especially the anticoagulant system. Thyroid hormones should be checked, and hormone replacement therapy should be applied if necessary in patients who are followed up due to coagulation tendency.