Anemia pattern in newly diagnosed hypothyroid patients presenting to Khyber Teaching Hospital Peshawar
DOI:
https://doi.org/10.59736/IJP.24.03.1135Keywords:
Hypothyroidism, Microcytic Anemia, Macrocytic AnemiaAbstract
Background: Insufficient release of thyroid hormone can cause hypothyroidism; the etiology and manifestation are different among individuals. Both Anemia and thyroid disease are interconnected and highly prevalent disease. Beside substantial literature about anemia and thyroid function are present but the clear characterization about the anemia patterns in newly diagnosed hypothyroid patients remain unclear, specifically in South Asian population.
Methods: A cross-sectional study was conducted at the Department of General Medicine, Khyber Teaching Hospital Peshawar, from 25th December 2022 to 25th November 2023. A total of 229 newly diagnosed hypothyroid patients were enrolled using non-probability consecutive sampling. Anemia morphology was determined among 111 (48.5%) anemic patients and classified on the basis of mean corpuscular volume (MCV) into normocytic normochromic (MCV 76–96 fL), microcytic hypochromic (MCV <76fL), and macrocytic (MCV >96 fL). Stratification by age, gender, and socioeconomic status was performed. Chi-square test was applied; p ≤ 0.05 was considered statistically significant
Results: The mean age was 51.108±8.15 years (range 18–70). Of 229 patients, 94 (41.0%) were male and 135 (59.0%) female. Anemia morphology was determined among 111 (48.5%) anemic patients. Among anemic patients, normocytic normochromic anemia was the most prevalent type (54.1%, n=60), followed by microcytic anemia (27.9%, n=31) and macrocytic anemia (18.0%, n=20). No statistically significant association was found between anemia pattern and age, gender, or socioeconomic status (p>0.05 for all).
Conclusion: Anemia is present in approximately half of newly diagnosed hypothyroid patients. Normocytic normochromic anemia is the predominant morphological type. Clinicians should perform routine hematological evaluation at the time of hypothyroidism diagnosis and Thyroid function testing may be warranted in patients with unexplained normocytic anemia.
References
Chiovato L, Magri F, Carlé A. Hypothyroidism in context: where we've been and where we're going. Adv Ther. 2019;36 Suppl 2:47-58.
Almandoz JP, Gharib H. Hypothyroidism: etiology, diagnosis, and management. Med Clin North Am. 2012;96(2):203-21.
Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-751.
Vargas-Uricoechea H, Mera-Mamian A, Bastidas-Sanchez B, Pinzon-Fernandez M, Murillo-Palacios J, Ramirez-Bejarano L. Population status of iodine and its potential effects on thyroid function and autoimmunity in Southwestern Colombia. J Clin Med Res. 2022;14(3):126-34.
Klubo-Gwiezdzinska J, Wartofsky L. Hashimoto thyroiditis: an evidence-based guide to etiology, diagnosis and treatment. Pol Arch Intern Med. 2022;132(3):16222.
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 Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489-99.
Attaullah S, Haq BS, Muska M. Thyroid dysfunction in Khyber Pakhtunkhwa, Pakistan. Pak J Med Sci. 2016;32(1):111-5.
Wopereis DM, Du Puy RS, Van Heemst D, Walsh JP, Bremner A, Bakker SJ, et al. The relation between thyroid function and anemia: a pooled analysis of individual participant data. J Clin Endocrinol Metab. 2018;103(10):3658-67.
Dorgalaleh A, Mahmoodi M, Varmaghani B, Kia OS, Alizadeh S, Tabibian S, et al. Effect of thyroid dysfunctions on blood cell count and red blood cell indices. Iran J Pediatr Hematol Oncol. 2013;3(2):73-8.
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(1):151-6.
Aon M, Taha S, Mahfouz K, Ibrahim MM, Aoun AH. Vitamin B12 (cobalamin) deficiency in overt and subclinical primary hypothyroidism. Clin Med Insights Endocrinol Diabetes. 2022; 15:11795514221086634.
Centanni M, Marignani M, Gargano L, Corleto VD, Casini A, Delle Fave G, et al. Atrophic body gastritis in patients with autoimmune thyroid disease: an underdiagnosed association. Arch Intern Med. 1999;159(15):1726-30.
Anand R, Mishra AK, Mahdi AA, Verma SP, Gupta KK. A study of prevalence and pattern of anemia in primary hypothyroidism. Int J Med Sci Public Health. 2018;7(2):153-60.
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4.
Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200-35.
Dacie JV. Dacie and Lewis practical hematology. Edinburgh: Elsevier Health Sciences; 2006.
Marn H, Critchley JA. Accuracy of the WHO Hemoglobin Colour Scale for the diagnosis of anemia in primary health care settings in low-income countries: a systematic review and meta-analysis. Lancet Glob Health. 2016;4(4): e251-65.
Ali SS, Khan MN, Zafar F, Adnan STA, Yusuf A, Hussnain M, et al. Frequency and types of anemia in primary hypothyroidism patients: a prospective observational study. Cureus. 2024;16(4): e58004.
Abdelnaser M, Rezk AA, Al Adl HA, Mahfouz KA-E-H. Pattern of blood cell parameters in thyroid dysfunction. Al-Azhar Int Med J. 2022;3(1):42-6.
Gadó K, Khodier M, Virág A, Domján G, Dörnyei G. Anemia of geriatric patients. Physiol Int. 2022;109(2):119-34.
Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011-23.
Mehmet E, Aybike K, Ganidagli S, Mustafa K. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocr J. 2012;59(3):213-20.
Berta DM, Gelaw Y, Shiferaw E, Melkamu A, Legese GL, Adane T, et al. Hematological abnormalities and associated factors among patients with hypothyroidism at the University of Gondar Comprehensive Specialized Hospital. J Blood Med. 2024:157-69.
Szczepanek-Parulska E, Hernik A, Ruchała M. Anemia in thyroid diseases. Pol Arch Intern Med. 2017;127(5):352-60.
Ravanbod M, Asadipooya K, Kalantarhormozi M, Nabipour I, Omrani GR. Treatment of iron-deficiency anemia in patients with subclinical hypothyroidism. Am J Med. 2013;126(5):420-4.
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