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In hyperthyroidism, a prothrombotic state is commonly observed, characterized by increased fibrinogen concentrations, elevated D-dimer levels, and enhanced coagulation activation. Conversely, hypothyroidism may impair coagulation and fibrinolysis, resulting in variable bleeding or thrombotic manifestations depending on disease severity. Raised D\u2011dimer levels reflect increased thrombin generation with secondary fibrinolysis and therefore serve as markers of a hypercoagulable state. Fibrinogen concentrations above 4.0\u00a0g\/L are independently associated with a higher risk of venous thromboembolism, although a direct causal role has not been established. In patients with hyperthyroidism, fibrinogen levels are increased by approximately 20% on average, suggesting an elevated thrombotic risk, potentially mediated by reduced fibrinolytic capacity. Hyperthyroid patients consistently demonstrate higher plasma D\u2011dimer concentrations, indicating concurrent activation of coagulation and fibrinolysis. Previous studies have documented increased D\u2011dimer levels in both overt and subclinical hyperthyroidism, consistent with upregulation of the fibrinolytic pathway. D\u2011dimer values in the range of approximately 450\u2013650 ng\/mL are frequently observed in this population. In moderate hypothyroidism, relatively lower D\u2011dimer levels have been linked to diminished fibrinolytic activity. Bleeding manifestations have been frequently reported in patients with hypothyroidism, although their prevalence varies considerably depending on the study population and clinical criteria used. In contrast, thrombotic complications are more commonly associated with hyperthyroidism, with reported frequencies varying widely across studies due to differences in disease severity, population characteristics, and outcome definitions. In summary, thyroid dysfunction disturbs hemostatic equilibrium and leads to characteristic changes in fibrinogen and D\u2011dimer levels. Abnormal concentrations of these markers may signal impaired hemostatic function and could help identify patients at increased risk of bleeding or thrombosis.<\/jats:p>","DOI":"10.1186\/s13044-026-00312-8","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:12:55Z","timestamp":1785168775000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fibrinogen and D-dimer alterations in thyroid dysfunction: implications for bleeding and thrombotic risk"],"prefix":"10.1186","volume":"19","author":[{"given":"Befikad","family":"Mandefro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanuel","family":"Kelem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiruneh","family":"Adan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"issue":"4","key":"312_CR1","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1111\/cen.12767","volume":"84","author":"N Kyriakakis","year":"2016","unstructured":"Kyriakakis N, Lynch J, Ajjan R, Murray RD. 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