Impact of subclinical hypothyroidism on iron status and hematological parameters
Keywords:
Subclinical hypothyroidism, serum Ferritin, Red Blood cell Indices, Mean corpuscular volume [MCV], Mean corpuscular hemoglobin concentration [MCHC], Anemia
Abstract
Background: Thyroid hormones play an important physiological role to maintain balance of metabolism of entire human body. Erythrocyte abnormalities are frequently associated with thyroid disorder. Subclinical hypothyroidism, often a hidden condition, is associated with iron-deficiency anemia along with other disorders. Thyroid hormones have a crucial role in metabolism and proliferation of blood cells. Thyroid dysfunction induces different effects on blood cells such as anemia, alters RBC indices including MCV and MCHC. In this study it was attempted to evaluate effect of subclinical hypothyroidism on hematological parameters and body iron storeMethods: This retrospective study included 158 subjects, among which 118 were newly diagnosed, untreated subclinical hypothyroid [n=118], and 40 healthy euthyroid [n=40] individuals. The hematological parameters and thyroid profile of the subjects were assessed by the mean, standard deviation [SD]. Student’s t-test was used to report our results, with p-value < 0.05 considered as statistically significant.Results: In this study we have compared hemoglobin level, red cell indices, serum Ferritin among study group and euthyroid healthy group and found that mean hemoglobin, serum ferritin and RBC indices were significantly depleted in subclinical hypothyroid patient in comparison to euthyroid group. 21 of total 118 [17.8%] newly diagnosed subclinical hypothyroid patients was suffering from Iron deficiency anemia with hemoglobin level less than 10 g%.Conclusion: Subclinical hypothyroidism is often associated with anemia, depleted body iron store and complication of getting converted into primary hypothyroidism. As there is no significant clinical manifestation of SCH at earlier stages with anemia it is advisable to routinely investigate it for early detection allowing its early management.References
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17. Golde DW, Bersch N, Chopra IJ, Cline MJ. Thyroid hormones stimulate erythropoiesis in vitro. Br J Haematol. 1977; 37:173-7.
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21. Menon UV, Sundaram KR, Unnikrishnan AG, Jaya-kumar RV, Nair V, Kumar H . High prevalence of undetected thyroid disorders in an iodine sufficient adult south Indian population .J Indian Med Assoc. 2009; 107:72-7
22. Fujita H. Fine structure of the thyroid gland. Int Rev Cytol.1975; 40:197-280.
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24. Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Sub clinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004; 291: 228-3.
25. Bashir H, Bhat MH, Farooq R, Majid S, Sheikh S, Rabia. Comparison of hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients. Medical Journal of Islamic Republic of Iran. 2012; 26:172-178
26. Lauritano EC, Bilotta AL, Gabrielli M, Scarpellini E, Lupascu A, Laginestra A, et al. Association between hypothyroidism and small intestinal bacterial over-growth. J Clin Endocrinol Metab. 2007; 92: 4180.
27. Elfstrom P, Montgomery SM, Kampe O, Ekbom A, Ludvigsson JF. Risk of thyroid disease in individuals with celiac disease. J Clin Endocrinol Metab. 2008; 93: 3915.
28. Ravanbod M, Asadipooya K, Kalantarhormozi M, Nabipour I, Omrani GR. Treatment of Iron-deficiency Anemia in Patients with Subclinical Hypothyroidism . Am J of Med.2013; 126: 420-4.
2. Haamid B, Mohammad HB, Sheikh S, Rabia F, Rabia H, Sabhiya M. Hypothyroidism: its screening and management and role in erythrocyte abnormalities: a systematic review. Int J Med Pharm Sci. 2013; 03:18-24
3. Cinemre H, Bilir C, Gokosmanoglu F, Bahcebasi T. Hematologic effects of levothyroxine in iron-deficient subclinical hypothyroid patients: a randomized, double-blind, controlled study. J Clin Endocrinol Metab. 2009; 94:151-6.
4. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000; 160:526-34.
5. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T4, and thyroid antibodies in the United States population [1988 to 1994]: National Health and Nutrition Ex-amination Survey [NHANESIII]. J Clin Endocrinol Metab. 2002; 87:489-99.
6. Bagchi N, Brown TR, Parish RF. Thyroid dysfunction in adults over age 55 years. A study in an urban US community. Arch Intern Med .1990; 150:785-7.
7. Sawin CT, Chopra D, Azizi F, Mannix JE, Bacharach P. The aging thyroid. Increased preva- lence of elevated serum thyrotropin levels in the elderly. JAMA .1979; 242:247-50.
8. Wilson GR, Curry RW Jr. Subclinical thyroid disease. Am Fam Physician. 2005; 72: 1517-24.
9. Kosenli A, Erdogan M, Ganidagli S, Kulaksizoglu M, Solmaz S, Kosenli O, et al. Anemia frequency and etiology in primary hypothyroidism. Endocr Abstr. 2009; 20:140.
10. Chu JY, Monteleone JA, Peden VH, Graviss ER, Vernava AM. Anemia in children and adolescents with hypothyroidism. Clin Pediatr [Phila]. 1981; 20: 696-9.
11. Franzese A, Salemo M, Argenziano A, Buongiovanni C, Limauro R, Tenore A. Anemia in infants with congenital hypothyroidism diagnosed by neonatal screening. J Endocrinol Invest. 1996; 19:613-19.
12. Lippi G, Montagnana M, Salvagno GL and Guidi GC. Should women with abnormal serum thyroid stimu-lating hormone undergo screening for Anaemia? Arch Pathol Lab Med. 2008; 132:321- 2.
13. Kawa MP, Grymuła K, Paczkowska E, BaśkiewiczMasiuk M, Dąbkowska E, Koziołek M, et al. Clinical relevance of thyroid dysfunction in human haematopoiesis: biochemical and molecular studies. Eur J Endocrinol. 2010; 162:295-305.
14. Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. J Clin Endocrinol Metab. 2005;90: 581-7.
15. Zimmermann MB, Kohrle J. The Impact of Iron and Selenium Deficiencies on Iodine and Thyroid meta-bolism: Biochemistry and Relevance to Public Health. N Eng J Med. 2002; 12: 867-78.
16. Drews RE. Critical issues in hematology: anemia, thrombocytopenia, coagulopathy, and blood product transfusions in critically ill patients. Clin Chest Med 2003; 24:607-22.
17. Golde DW, Bersch N, Chopra IJ, Cline MJ. Thyroid hormones stimulate erythropoiesis in vitro. Br J Haematol. 1977; 37:173-7.
18. Mackenzie GM. Anemia in hypothyroidism. JAMA. 1926; 86:462-64.
19. http://www.unicef.org/india/10._National_Iron_Plus_Initiative_Guidelines_for_Control_of_IDA.pdf
20. Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J En-docrinol Metab. 2011; 15: S78–S81.
21. Menon UV, Sundaram KR, Unnikrishnan AG, Jaya-kumar RV, Nair V, Kumar H . High prevalence of undetected thyroid disorders in an iodine sufficient adult south Indian population .J Indian Med Assoc. 2009; 107:72-7
22. Fujita H. Fine structure of the thyroid gland. Int Rev Cytol.1975; 40:197-280.
23. Das KC, Mukherjee M, Sarkar TK, Dash RJ, Rastogi GK. Erythropoiesis and erythropoietin in hypo and hyperthyroidism. J Clin Endocrinol Metab 1975; 40:211-20.
24. Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Sub clinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004; 291: 228-3.
25. Bashir H, Bhat MH, Farooq R, Majid S, Sheikh S, Rabia. Comparison of hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients. Medical Journal of Islamic Republic of Iran. 2012; 26:172-178
26. Lauritano EC, Bilotta AL, Gabrielli M, Scarpellini E, Lupascu A, Laginestra A, et al. Association between hypothyroidism and small intestinal bacterial over-growth. J Clin Endocrinol Metab. 2007; 92: 4180.
27. Elfstrom P, Montgomery SM, Kampe O, Ekbom A, Ludvigsson JF. Risk of thyroid disease in individuals with celiac disease. J Clin Endocrinol Metab. 2008; 93: 3915.
28. Ravanbod M, Asadipooya K, Kalantarhormozi M, Nabipour I, Omrani GR. Treatment of Iron-deficiency Anemia in Patients with Subclinical Hypothyroidism . Am J of Med.2013; 126: 420-4.
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