DOI: https://doi.org/10.18370/2309-4117.2020.51.60-62

Associative relations between hypofunction of the thyroid gland of various origins and iron deficiency anemia

О. А. Гончарова

Abstract


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.


Keywords


hypothyroidism; iron deficiency anemia; autoimmune thyroiditis; nodular nontoxic goiter

References


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.


GOST Style Citations


1.            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].

2.            Rizaeva, L. “Epidemiology of the prevalence of iron deficiency anemia.” International scientific review 2.33 (2017): 108–9.

3.            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

4.            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

5.            Shchekotova, А.P. “Diagnosis of Anemia.” Therapy 5 (2016): 76–86.

6.            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

7.            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

8.            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

9.            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

10.          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).

11.          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

12.          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

13.          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

14.          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

15.          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.

16.          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

17.          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

18.          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

19.          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

20.          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

21.          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

22.          Antonelli, A., Benvengra, S. “The Association of Other Autoimmune Diseases in Patients With Thyroid Autoimmunity.” Front Endocrinol (2018). DOI: 10.3389/fendo.2018.00540

23.          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

24.          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.

25.          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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