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Review
. 2021 May 25;14(1):12.
doi: 10.1186/s13044-021-00102-4.

The interrelationship between pregnancy, venous thromboembolism, and thyroid disease: a hypothesis-generating review

Stine Linding Andersen  1   2 , Kasper Krogh Nielsen  3   4 , Søren Risom Kristensen  3   4
Affiliations
Review

The interrelationship between pregnancy, venous thromboembolism, and thyroid disease: a hypothesis-generating review

Stine Linding Andersen et al. Thyroid Res. .

Abstract

Pregnancy induces physiological changes that affect the risk of thrombosis and thyroid disease. In this hypothesis-generating review, the physiological changes in the coagulation system and in thyroid function during a normal pregnancy are described, and the incidence of venous thromboembolism (VTE) and thyroid disease in and after a pregnancy are compared and discussed. Furthermore, evidence regarding the association between thyroid disease and VTE in non-pregnant individuals is scrutinized. In conclusion, a normal pregnancy entails hormonal changes, which influence the onset of VTE and thyroid disease. Current evidence suggests an association between thyroid disease and VTE in non-pregnant individuals. This review proposes the hypothesis that maternal thyroid disease associates with VTE in pregnant women and call for future research studies on this subject. If an association exists in pregnant women specifically, such findings may have clinical implications regarding strategies for thyroid function testing and potential thromboprophylaxis in selected individuals.

Keywords: Coagulation; Postpartum; Pregnancy; Thrombosis; Thyroid.

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Conflict of interest statement

The author declares that she has no competing interests.

Figures

Fig. 1
Fig. 1
A simplified overview of the secondary hemostasis including the main alterations in pregnancy. Factors that considerably change in pregnancy are marked in bold (protein S (PS) decreases, others increase), and anticoagulants are marked in italic. See text for details. AT; antithrombin, PAI-1; plasminogen activator inhibitor-1, PAI-2: plasminogen activator inhibitor-2, PCa; activated protein C, TF: tissue factor, TFPI; tissue factor pathway inhibitor, t-PA; tissue-type plasminogen activator
Fig. 2
Fig. 2
Illustration of the incidence rates of venous thromboembolism, hyperthyroidism, and hypothyroidism in and around pregnancy. The illustration is made using data from Danish nationwide investigations [1, 6, 7]
Fig. 3
Fig. 3
Illustration of the upper (97.5 percentile) and lower (2.5 percentile) reference limit with 95% confidence interval for maternal thyroid stimulating hormone (TSH) in early pregnancy stratified by weeks of pregnancy. Data are from a regional Danish investigation in which maternal TSH was assessed using different biochemical methods (filled circles: Cobas 8000, Roche Diagnostics, open circles: ADVIA Centaur XPT, Siemens Healthineers) [34]
See this image and copyright information in PMC

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