Evaluation of hemostasis in hyperthyroid cats

Background: Hyperthyroid cats are predisposed to thrombus formation. The mechanism for thrombogenesis is currently unknown, but could be associated with altered hemostasis as seen in hyperthyroid humans.

Objective: The purpose of this study was to evaluate markers of hemostasis in hyperthyroid cats compared to healthy cats, and in hyperthyroid cats before and after treatments with radioactive iodine (RIT).

Methods: Twenty-five cats with hyperthyroidism and 13 healthy euthyroid cats > 8 years of age were studied. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, antithrombin (AT), D-dimers, thrombin-antithrombin complexes (TAT), von Willebrand Factor antigen (vWF:Ag), and activity of factors VIII and IX were measured. An echocardiogram was performed in all cats and healthy cats with abnormal echocardiograms were excluded. Measurements of hemostasis were evaluated again in 7 cats > 6 months after RIT and deemed to have restored euthyroid status.

Results: There is a significant likelihood of being in hypercoagulable state based on hyperthyroid state (P = 0.019) and serum T4 level is significantly associated with predicating hypercoagulability (P = 0.043). Hyperthyroidism is associated with significantly higher median fibrinogen concentration (P < 0.0001), higher median AT activity (P < 0.0001), and higher median vWF:Ag level (P = 0.01) with all values decreasing significantly post-RIT. Fibrinogen and AT had a strong positive correlation with serum T4 value (r = 0.79; 95% CI 0.63 - 0.89 and r = 0.70; 95% CI 0.50 - 0.84, respectively). Presence of an abnormal echocardiogram in hyperthyroid cats was associated with a significantly higher median fibrinogen concentration (P = 0.03). Echocardiographic status did not have a significant impact on the remaining hemostatic markers in hyperthyroid cats.

Conclusions: These results provide evidence of altered hemostasis and hypercoagulability in hyperthyroid cats that do not appear to be solely attributed to cardiac abnormalities. These differences of altered hemostasis resolved after radioiodine therapy, but further studies are warranted to determine if hypercoagulable state resolves.