Associative relations between hypofunction of the thyroid gland of various origins and iron deficiency anemia
Keywords:hypothyroidism, iron deficiency anemia, autoimmune thyroiditis, nodular nontoxic goiter
Background. Anemia is one of the thyroid deficiency manifestations, more often iron deficiency. The combination of hypothyroidism and anemia is an additional factor complicating the life quality of patients and requiring of adequate preventive measures.
Purpose of the study was to establish the peculiarities of iron deficiency anemia in women with hypothyroidism that arose against the background of autoimmune thyroiditis (AIT) or after surgical treatment of nodular nontoxic goiter (NNG).
Materials and methods. Thyroid status was assessed in 40 women with anemia on the background of hypothyroidism due to AIT (n = 28) and after surgery for NNG (n = 12) by the level of thyroid stimulating hormone and bound tetraiodothyronine, antibodies to thyroperoxidase. Anemia and its severity were determined by the blood hemoglobin level, number of red blood cells and color indicator.
Study results. Level of thyroid stimulating hormone was increased in women of both groups on the background of levothyroxine in an individually selected dose, and it was significantly higher in group with postoperative hypothyroidism. Level of antibodies to thyroid peroxidase testified to the pronounced activity of antithyroid immunity in the group with AIT. Hemoglobin level in both groups ranged from 92 to 116 g/l, which according to WHO criteria corresponded to mild anemia. It was significantly lower than with postoperative hypothyroidism against the background of AIT, despite the best compensation for hypothyroidism. Color index in both groups was reduced, that is typical for hypochromic anemia, which includes iron deficiency anemia.
Conclusions. Effectiveness of levothyroxine treatment in individually selected doses in women with a combination of hypothyroidism and anemic syndrome is higher at autoimmune thyroid pathology than after surgery for NNG. Active autoimmune process in women with hypothyroidism on the background of AIT is associated with more manifest anemia than in women with postoperative hypothyroidism as a result of NNG.
World Health Organization. Worldwide prevalence of anaemia 1993–2005. WHO Global Database on Anaemia. Geneva. WHO (2008). Available from: [http://whqlibdoc. who.int/publications.2008/9789241596657_eng.pdf].
Rizaeva, L. “Epidemiology of the prevalence of iron deficiency anemia.” International scientific review 2.33 (2017): 108–9.
Szczepanek-Parulska, E., Hernik, A., Ruchała, M. “Anemia in thyroid diseases.” Pol Arch Intern Med 127.5 (2017): 352–60. DOI: 10.20452/pamw.3985
Dignass, A.U., Gasche, C., Bettenworth, D., et al. “European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases.” J Crohns Colitis 9.3 (2015): 211–22. DOI: 10.1093/ecco-jcc/jju009
Shchekotova, А.P. “Diagnosis of Anemia.” Therapy 5 (2016): 76–86.
Erdogan, M., Kosenli, A., Ganidagli, S., et al. “Characteristics of anemia in subclinical and overt hypothyroid patients.” Endocr J 59 (2012): 213–20. DOI: 10.1507/endocrj.ej11-0096
Bremner, A.P., Feddema, P., Joske, D.J., et al. “Significant association between thyroid hormones and erythrocyte indices in euthyroid subjects.” Clin Endocrinol (Oxf) 76.2 (2012): 304–11. DOI: 10.1111/j.1365-2265.2011.04228.x
Wopereis, D.M., Du Puy, R.S., van Heemst, D., et al. “The Relation Between Thyroid Function and Anemia: A Pooled Analysis of Individual Participant Data.” J Clin Endocrinol Metab 103.10 (2018): 3658–67. DOI: 10.1210/jc.2018-00481
Shevchenko, U.L., Melnichenko, V.Y., Fedorenko, D.A. “Anemic syndrome in clinical practice: principles of diagnosis.” Archive of Internal Medicine 1.3 (2012): 59–63. DOI: 10.20514/2226-6704-2012-0-1-59-63
Gromova, О.А., Rakhteenko, А.V., Gromova, M.А. Iron-deficiency anemia. Therapeutic Reference. Guidelines for medical appointments: a modern guide for practitioners: [neurologists, cardiologists, endocrinologists, rheumatologists, otorhinolaryngologists, pulmonologists, hematologists. Vol. 3, ed. by А. I. Martynov. Мoscow. Bionics Media (2016).
Floriani, C., Feller, M., Aubert, C.E., et al. “Thyroid dysfunction and anemia: a prospective cohort study and a systematic review.” Thyroid 28.5 (2018): 575–82. DOI: 10.1089/thy.2017.0480
Ghiya, R., Ahmad, S. “Severe Iron-Deficiency Anemia Leading to Hypothyroidism.” J Endocr Soc 3 Suppl. 1 (2019): SUN-591. DOI: 10.1210/js.2019-SUN-591
Ashart, T.S., De Sanctis, V., Yassin, M., et al. “Chronic anemia and thyroid function.” Acta Biomed 88.1 (2017): 119–27. DOI: 10.23750/abm.v88i1.6048
Das, C., Sahana, P.K., Sengupta, N., et al. “Etiology of anemia in primary hypothyroid subjects in a tertiary care center in Eastern India.” Indian J Endocrinol Metab 16.2 (2012): S361–S363. DOI: 10.4103/2230-8210.104093
Gorokhobskaya, G.N., Un, V.L. “Iron deficiency conditions in the practice of a therapist. Features of iron deficiency and prevention of iron deficiency anemia.” Medical advice 1 (2014): 85–92.
Khatiwada, S., Gelal, B., Baral, N., Lamsal, M. “Association between iron status and thyroid function in Nepalese children.” Thyroid Res 9.2 (2016). DOI: 10.1186/s13044-016-0031-0
Moreno-Fernandez, J., Díaz-Castro, J., Alférez, M.J.M., López-Aliaga, I. “Iron Deficiency and Neuroendocrine Regulators of Basal Metabolism, Body Composition and Energy Expenditure in Rats.” Nutrients 11.3 (2019): E 631. DOI: 10.3390/nu11030631
Banday, T.H., Bhat, S.B., Bashir, S., Naveed, S. “Incipient iron deficiency in primary hypothyroidism.” Thyroid Research and Practice 15.3 (2018): 138–41. DOI: 10.4103/0973-0354.245563
Kotb, A.M., Hekma, S.F., Asmaa, F.H. “Thyroid status in Egyptian primary school children with iron deficiency anemia: Relationship to intellectual function.” Thyroid Research and Practice 10.3 (2013): 91–5. DOI: 10.4103/0973-0354.116131
Shuxiang Li, Xin Gao, Yancai Wei et al. “The relationsheep between iron deficiency and thyroid function in Chinese women during early pregnancy.” J Nutr Sci Vitaminiol 62 (2016): 397–401. DOI: 10.3177/jnsv.62.397
Cellini, M., Santaguida, M.G., Virili, C., et al. “Hashimoto’s thyroiditis and autoimmune gastritis.” Front Endocrinol (Lausanne) 8 (2017): 92. DOI: 10.3389/fendo.2017.00092
Antonelli, A., Benvengra, S. “The Association of Other Autoimmune Diseases in Patients With Thyroid Autoimmunity.” Front Endocrinol (2018). DOI: 10.3389/fendo.2018.00540
Johnson-Wimbley, T.D., Graham, D.Y. “Diagnosis and management of iron deficiency anemia in the 21st century.” Therap Adv Gastroenterol 4.3 (2011): 177–84. DOI: 10.1177/1756283X11398736
Dahlerup, J.F., Eivindson, M., Jacobsen, B.A., et al. “Diagnosis and treatment of unexplained anemia with iron deficiency without overt bleeding.” Dan Med J 62.4 (2015): C5072.
Selchuk, V.U., Chistyakov, S.S., Maznuk, L.V., et al. “Iron deficiency anemia: current status of the problem.” RMJ 1 (2012): 1–8.
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