Evaluation of new biomarkers as a predictor for thrombosis in patients with thyroid dysfunction

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Introduction
The thyroid weighs about 20 grammes and is the most significant endocrine organ in the body.The right lobe is typically bigger than the left.At the age of 15, a person reaches full size.A small isthmus located just below the cricoid cartilage connects the two lateral lobes, which are located anterior to the cricoid cartilage.Intrathyroidal factors, commonly the quantity of iodide within the thyroid cell, and extrathyroidal factors, such as the thyroidstimulating immunoglobulin in Graves' disease, both affect the synthesis of thyroid hormone [1].
The extrathyroidal 5-deiodination of T4 yields the majority of T3, which can be altered without affecting thyroid function.Two types of 5-deiodinases convert T4 into T3 in this process.
The adhesion of T3 to nuclear thyroid hormonespecific receptors mediates the majority of thyroid hormone effects.The greater biologic activity of T3 is due to its ten-fold higher specificity for this receptor complex compared to T4 [2] Through the vasculature, blood moves as a liquid under pressure.The process that causes a blood vessel to stop bleeding is known as hemostasis.The blood vessels' endothelium preserves an antithrombotic outer layer that keeps the blood in a fluid state [3].
Hemolysis is not formally defined by any single authority.The simplest definition is the "cessation of bleeding," but since death ultimately causes the bleeding to stop, it is not a good illustration of hemostasis.The control of bleeding without the induction of pathologic thrombotic events like coronary artery disease, cerebrovascular disease, arterial thrombosis, or peripheral arterial disease is a more precise clinical definition of hemostasis [4].
At the start of the previous century, the clinical connection between thyroid disorders & the blood coagulation system had first been established.In cases of thyroid dysfunction, multiple newly discovered defects of the coagulation-fibrinolytic process have been documented.These deviations can be anything from mild laboratory anomalies to serious hemostasis disorders [5].

Subjects
The sample size was calculated using G-

Exclusion criteria
Patients who exhibited the traits listed below were ineligible: • Age > 70.
• A history of cancer.
• Previous thromboembolic incidents or bleeding issues.
• Patients taking OCPS or oral anticoagulants.

Study design
The following information was acquired on 60 people between February 2021 and October 2021 from the Fayoum University Hospitals in the Fayoum Governorate.The patients were divided into three groups: 1. Group A: 20 patients with hyperthyroidism on TT and have an increased thyroid function.
3. Group C: 20 people had normal thyroid function (the euthyroid group).

Laboratory
examinations were performed on a sample of venous blood, including: • TSH, FT4; CBC; PT, PTT, and PC (prothrombin concentration).

Statistical Analysis
Complete medical history taking, including age, sex, smoking, blood disorders or thromboembolic events, usage of drugs, including OCPS, and clinical assessment were performed on every patient.were seen in hypothyroid states [10,11].I also disagreed with Shetty and Vijaya (2019), which showed that the lowest counts of TLC were discovered in the hypothyroid group, where they were significantly decreased in comparison to the hyperthyroid group but not reduced when contrasted with the euthyroid groups [12].
As regards HB level, the study agreed with Shetty and Vijaya, 2019 which showed that the RBCs in the hyper and euthyroid categories were within normal limits [12].On the other hand, the study disagreed with some previous studies as Dorgalaleh et al., 2013 and Ahmed and Mohammed, 2020 which showed that There was a significant relationship between anemia and thyroid dysfunction (P = 0.000), with 31.3% of cases suffering from anemia [6].
As regards PT-INR, these results agreed with Erem et al. (2003), who showed that PT in hyperthyroid patients was not different from the control subjects [13].Also, the results agreed However, further research is needed to determine the therapeutic effects of the temporary reduction in fibrinolytic activity that occurs when TSH levels return to normal.
On the other hand, the results disagreed with another previous study, which showed that the D-dimer level was statistically significantly greater in cases with hyperthyroidism contrasted with those normal healthy control groups (p < 0.001) [20].Also disagreed with the study conducted by Chadarevian et al. (2001), who showed that patients with severe hypothyroidism display both higher D-dimer levels and slightly lower fibrinogen levels than controls [21].
As regards the analysis to assess the P-selectin level: To assess human p-selectin in cell culture supernates, serum & plasma, the Quantikine® Human P-Selectin/CD62P Test is a 1.25-hour solid-phase ELISA.It includes antibodies produced in response to the recombinant factor and recombinant human pselectin.
prediction power of various investigations to the p-selectin level: The multivariate linear regression model analysis was performed to explore the explanatory power of various investigations on the p-selectin level.It demonstrated that there were statistically significant predictors of PTT, and PLT count levels with no prediction power to other investigations.That study agreed with Fei et al. (2016), as regards PLT count and its relation to p-selectin but disagreed with the same study as regards D-dimer [22].The previous study which showed that the level of D-dimer, p-selectin, and platelet count might be promising PVT diagnostic indicators, there is a positive relation between them.

Table 1 :
Comparison between study groups regarding PT profile.

Table 2 :
Comparison between study group as regards CBC component.

Table 3 :
Multivariate linear regression analysis to assess the prediction power of different investigation to p-selectin level.