Venous Thromboembolism in Patients Hospitalized With Thyroid Dysfunction

Abstract

The objective of this investigation is to explore a possible role of thyroid dysfunction in venous thromboembolism (VTE). The number of patients discharged from short-stay nonfederal hospitals in the United States, from 1979 to 2005, with a diagnostic code for hypothyroidism or hyperthyroidism, pulmonary embolism (PE), and deep venous thrombosis (DVT) was obtained from the National Hospital Discharge Survey (NHDS). Among 19 519 000 hospitalized patients discharged with a diagnosis of hypothyroidism from 1979 to 2005, 119 000 (0.61%) had PE. Among patients with no thyroid dysfunction, PE was diagnosed in 3 372 000 of 908 805 000 patients (0.37%; relative risk = 1.64, 95% CI 1.63-1.65). Deep venous thrombosis was diagnosed in 1.36% of hypothyroid patients and in 0.84% of patients with no thyroid dysfunction (relative risk = 1.62, 95% CI 1.61-1.62). The relative risk of PE in patients with hypothyroidism was highest in patients <40 years of age (relative risk = 3.99) and the relative risk of DVT was also highest in patients <40 years (relative risk = 2.25). Hyperthyroidism was not associated with an increased risk of VTE (relative risk = 0.98, 95% CI = 0.96-1.01). In conclusion, an increased risk of PE, DVT, and VTE was shown in patients with hypothyroidism but not hyperthyroidism. Antithrombotic prophylaxis in patients with severe hypothyroidism, however, should be viewed with caution because of a possible hyperfibrinolytic state in such patients.