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J Clin Endocrinol Metab. 2018 Oct 1;103(10):3658-3667. doi: 10.1210/jc.2018-00481.

The Relation Between Thyroid Function and Anemia: A Pooled Analysis of Individual Participant Data.

Author information

1
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.
2
Department of Internal Medicine, Gerontology and Geriatrics Section, Leiden University Medical Center, Leiden, Netherlands.
3
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia.
4
Medical School, The University of Western Australia, Crawley, Perth, Western Australia.
5
School of Population Health, The University of Western Australia, Crawley, Perth, Western Australia.
6
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
7
Department of Medicine, University of California San Francisco, San Francisco, California.
8
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
9
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
10
Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, Parma, Italy.
11
Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.
12
Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.
13
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
14
Institute of Primary Health Care, University of Bern, Bern, Switzerland.
15
National Institute on Aging, Baltimore, Maryland.
16
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
17
University Cardiology Unit, Cardiothoracic Department, University Policlinic Hospital, Bari, Italy.
18
National Council Research Institute of Clinical Physiology/Tuscany Region G. Monasterio Foundation, Pisa, Italy.
19
Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan.
20
Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
21
Department of Public Health and Primary Care, University of Cambridge, Cambridge, England.
22
National Council Research Institute of Clinical Physiology, Pisa, Italy.
23
Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
24
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
25
Department of Internal Medicine, Rotterdam Thyroid Center, Erasmus MC, Rotterdam, Netherlands.
26
Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington.
27
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
28
Department of Endocrinology, Gateshead Health Foundation NHS Trust, Gateshead, Tyne and Wear, England.
29
Department of Clinical Chemistry, Haematology and Immunology, Northwest Clinics, Alkmaar, Netherlands.
30
Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, Amsterdam, Netherlands.
31
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
32
The Physicians' Clinic, London, England.
33
Institute for Community Medicine, Study of Health in Pomerania/Clinical-Epidemiological Research and German Centre of Cardiovascular Research, University of Greifswald, Greifswald, Germany.
34
Department of Public Health and Center of Healthy Aging, University of Copenhagen, Copenhagen, Denmark.
35
Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands.

Abstract

Context:

Anemia and thyroid dysfunction often co-occur, and both increase with age. Human data on relationships between thyroid disease and anemia are scarce.

Objective:

To investigate the cross-sectional and longitudinal associations between clinical thyroid status and anemia.

Design:

Individual participant data meta-analysis.

Setting:

Sixteen cohorts participating in the Thyroid Studies Collaboration (n = 42,162).

Main Outcome Measures:

Primary outcome measure was anemia (hemoglobin <130 g/L in men and <120 g/L in women).

Results:

Cross-sectionally, participants with abnormal thyroid status had an increased risk of having anemia compared with euthyroid participants [overt hypothyroidism, pooled OR 1.84 (95% CI 1.35 to 2.50), subclinical hypothyroidism 1.21 (1.02 to 1.43), subclinical hyperthyroidism 1.27 (1.03 to 1.57), and overt hyperthyroidism 1.69 (1.00 to 2.87)]. Hemoglobin levels were lower in all groups compared with participants with euthyroidism. In the longitudinal analyses (n = 25,466 from 14 cohorts), the pooled hazard ratio for the risk of development of anemia was 1.38 (95% CI 0.86 to 2.20) for overt hypothyroidism, 1.18 (1.00 to 1.38) for subclinical hypothyroidism, 1.15 (0.94 to 1.42) for subclinical hyperthyroidism, and 1.47 (0.91 to 2.38) for overt hyperthyroidism. Sensitivity analyses excluding thyroid medication or high levels of C-reactive protein yielded similar results. No differences in mean annual change in hemoglobin levels were observed between the thyroid hormone status groups.

Conclusion:

Higher odds of having anemia were observed in participants with both hypothyroid function and hyperthyroid function. In addition, reduced thyroid function at baseline showed a trend of increased risk of developing anemia during follow-up. It remains to be assessed in a randomized controlled trial whether treatment is effective in reducing anemia.

PMID:
30113667
PMCID:
PMC6179176
DOI:
10.1210/jc.2018-00481
[Indexed for MEDLINE]
Free PMC Article

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