ACQUIRED VON WILLEBRAND DISEASE DUE TO SUBCLINICAL HYPOTHYROIDISM: A CASE REPORT

Abstract

Background:
Acquired von Willebrand Disease (VWD) is a rare bleeding disorder characterized by severe bleeding tendencies without prior personal or family history. It is often secondary to conditions such as lymphoproliferative or cardiovascular disorders and hypothyroidism, which reduce von Willebrand Factor (VWF) levels or function. Although acquired VWD has been associated with clinical hypothyroidism, reports of cases showing atypical features like neurological deficits due to subclinical hypothyroidism are rare.
Case Presentation:
A case of a 34-year-old man with bilateral lower limb weakness occurring suddenly after a history of mild trauma was reported at Lahore General Hospital. On clinical examination decreased muscular tone and strength with hyporeflexia was noted and image study revealed spinal extradural hematoma. Clotting investigations demonstrated a prolonged activated partial thromboplastin time (APTT) at presentation, and this was corrected on mixing. Further investigations showed low von Willebrand Factor (VWF) level (3,5%) confirming acquired VWD. Thyroid function tests showed subclinical hypothyroidism (elevated TSH level with normal T3 and T4 levels). The patient was treated with Humate-P and Tranexamic Acid replacement therapy and later with thyroid hormone replacement. Euthyrestoration led to the normalization of coagulability parameters and clinical improvement.
Conclusion:
This case demonstrates an unusual and previously undocumented association of subclinical hypothyroidism and acquired VWD, presenting atypically with spinal hematoma and neurologic symptoms. This underscores the importance of a thorough diagnostic workup for the treatment of bleeding disorders, which could even be seen with few underlying endocrine disorders.
Keywords:
Acquired Von willebrand disease, Bleeding disorder, Hematoma, Spinal extradural, Subclinical hypothyroidism, Von willebrand fact