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Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients with Primary Hypothyroidism

Year 2025, Volume: 17 Issue: 3, 281 - 286, 29.10.2025

Abstract

Objective: This study aimed to investigate the effects of hypothyroidism on hemoglobin, vitamin B12, iron, total iron-binding capacity (TIBC), ferritin, and mean corpuscular volume (MCV), and to evaluate the relationships between these parameters and thyroid-stimulating hormone (TSH), free thyroxine (fT4), and thyroid peroxidase antibody (anti-TPO) levels.
Method: This retrospective and descriptive study was conducted by reviewing the digital medical records of patients who presented to the Family Medicine Outpatient Clinic of the University of Health Sciences Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi between September 1, 2020, and September 1, 2022. A total of 200 patients diagnosed with hypothyroidism and 200 euthyroid individuals were included based on thyroid function test results. Demographic data including age, sex, and comorbid conditions were recorded. Laboratory parameters including TSH, fT4, anti-TPO, hemoglobin, vitamin B12, MCV, iron, TIBC, and ferritin levels were analyzed. Data analysis was performed using SPSS version 25.0.
Results: A total of 342 females and 58 males were included in the study. The mean age was 44.95 ± 12.52 years. TSH, anti-TPO, and TIBC levels were significantly higher, while fT4, hemoglobin, vitamin B12, MCV, iron, and ferritin levels were significantly lower in the hypothyroid group compared to the euthyroid group (p<0.001). Positive correlations were observed between fT4 and hematologic parameters, whereas TSH and anti-TPO showed negative correlations.
Conclusions: Hematological changes associated with anemia and vitamin B12 deficiency have been observed in patients with hypothyroidism. Therefore, regular monitoring of iron and vitamin B12 levels in these patients is important for early diagnosis and treatment.

References

  • 1. Türkiye Endokrinoloji ve Metabolizma Derneği Tiroid Çalışma Grubu. Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu. Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği; 2020 [cites 2025 Oct 17]. Available from: https://file.temd.org.tr/Uploads/publications/guides/documents/20200929134733-2020tbl_kilavuzf527c34496.pdf?a=1
  • 2. Romine MF, Rodionov DA, Maezato Y, Anderson LN, Nandhikonda P, Rodionova IA, et al. Elucidation of roles for vitamin B12 in regulation of folate, ubiquinone, and methionine metabolism. Proc Natl Acad Sci U S A. 2017;114(7):E1004-13.
  • 3. Oymak Y, İlhan G. Türk Hematoloji Derneği. Eritrosit hastalıkları ve hemoglobin bozuklukları tanı ve tedavi kılavuzu. Sürüm 1.1. İstanbul: Türk Hematoloji Derneği; 2019. [cited 2025 Oct 17]. Available from: https://thd.org.tr/thdData/userfiles/file/Ertitrosit-Tani-ve-tedavi-Kilavuzu-2019.pdf
  • 4. Zhang Y, Xue Y, Cao C, Huang J, Hong Q, Hai T, et al. Thyroid hormone regulates hematopoiesis via the TR-KLF9 axis. Blood. 2017;130(20):2161-70.
  • 5. Antonijević N, Nesović M, Trbojević B, Milosević R. Anemia in hypothyroidism. Med Pregl. 1999;52(3-5):136-40.
  • 6. Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. Am Fam Physician. 2012;86(3):244-51.
  • 7. Golde DW, Bersch N, Chopra IJ, Cline MJ. Thyroid hormones stimulate erythropoiesis in vitro. Br J Haematol. 1977;37(2):173-7. 8. Hu S, Rayman MP. Multiple nutritional factors and the risk of Hashimoto’s thyroiditis. Thyroid. 2017;27(5):597-610. 9. Zhang HY, Teng XC, Shan ZY, Wang ZJ, Li CY, Yu XH, et al. Association between iron deficiency and prevalence of thyroid autoimmunity in pregnant and non-pregnant women of childbearing age: a cross-sectional study. Chin Med J (Engl). 2019;132(18):2143-9.
  • 10. Szczepanek-Parulska E, Hernik A, Ruchała M. Anemia in thyroid diseases. Pol Arch Intern Med. 2017;127(5):352-60.
  • 11. Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923-31.
  • 12. Kim M, Kim BH, Lee H, Jang MH, Kim JM, Kim EH, et al. Association between serum free thyroxine and anemia in euthyroid adults: a nationwide study. Endocrinol Metab (Seoul). 2020;35(1):106-14. 13. van Vliet NA, Kamphuis AEP, Den Elzen WPJ, Blauw GJ, Gussekloo J, Noordam R, et al. Thyroid function and risk of anemia: a multivariable-adjusted and Mendelian randomization analysis in the UK Biobank. J Clin Endocrinol Metab. 2022;107(2):495-502.
  • 14. Lippi G, Montagnana M, Salvagno GL, Guidi GC. Should women with abnormal serum thyroid stimulating hormone undergo screening for anemia? Arch Pathol Lab Med. 2008;132(3):321-2. 15. Bashboosh NN. Correlation between hypothyroidism and iron deficiency anemia in female patients. World J Pharm Pharm Sci. 2017;6(1):80-9.
  • 16. Erdoğan M, Kosenli A, Ganıdagli S, Kulaksizoglu M. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocr J. 2012;59(3):213-20.
  • 17. Shetty A, Chowdappa V. Cytomorphological spectrum of Hashimoto’s thyroiditis and its correlation with hormonal profile and hematological parameters. J Cytol. 2019;36(3):137-43.
  • 18. Banday T, Bhat S, Bhat S, Shah N, Bashir S. To study prevalence of incipient iron deficiency in primary hypothyroidism. Int J Res Med Sci. 2014;2(2):472-6.
  • 19. Maldonado-Araque C, Valdés S, Lago-Sampedro A, Lillo-Muñoz JA, Garcia-Fuentes E, Perez-Valero V, et al. Iron deficiency is associated with hypothyroxinemia and hypotriiodothyroninemia in the Spanish general adult population: Di@bet.es study. Sci Rep. 2018;8(1):5118.
  • 20. Dahiya K, Verma M, Dhankhar R, Ghalaut VS, Ghalaut PS, Sachdeva A, et al. Thyroid profile and iron metabolism: mutual relationship in hypothyroidism. Indian J Endocrinol Metab. 2016;20(1):16-22.
  • 21. Jabbar A, Yawar A, Wasim S, Islam N, Ul Haque N, Zuberi L, et al. Vitamin B12 deficiency common in primary hypothyroidism. J Pak Med Assoc. 2008;58(5):258-61.
  • 22. Verma S, Thakur RK, Beg A, Sahoo SS, Mishra J, Trisal M. Vitamin B12 deficiency in subclinical hypothyroid: a pilot study. J Pharm Negat Results. 2022;13(7):2427-33.
  • 23. Khatiwada S, Gelal B, Baral N, Lamsal M. Association between iron status and thyroid function in Nepalese children. Thyroid Res. 2016;9(1):2.

Primer Hipotiroidi Hastalarında Hemoglobin, Demir, Ferritin ve B12 Değerlerinin İncelenmesi

Year 2025, Volume: 17 Issue: 3, 281 - 286, 29.10.2025

Abstract

Amaç: Bu çalışmada, hipotiroidinin hemoglobin, B12 vitamini, demir, toplam demir bağlama kapasitesi (DBK), ferritin ve ortalama eritrosit hacmi (MCV) üzerindeki etkileri ile bu parametrelerin tiroid stimülan hormon (TSH), serbest tiroksin (sT4) ve tiroid peroksidaz antikoru (anti-TPO) düzeyleriyle ilişkileri değerlendirilmiştir.
Yöntem: Bu çalışma, retrospektif ve tanımlayıcı bir araştırma olarak planlanmış olup, 1 Eylül 2020 ile 1 Eylül 2022 tarihleri arasında Sağlık Bilimleri Üniversitesi Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi Aile Hekimliği Polikliniği’ne başvuran hastaların dijital tıbbi kayıtları incelenerek gerçekleştirilmiştir. Çalışmaya, tiroid fonksiyon testlerine göre hipotiroidi tanısı almış 200 hasta ile tiroid fonksiyonları normal olan 200 ötiroid birey dâhil edilmiştir. Katılımcıların yaş, cinsiyet ve eşlik eden hastalık bilgileri kaydedilmiş; TSH, sT4, anti-TPO, hemoglobin, B12 vitamini, MCV, demir, DBK ve ferritin düzeyleri değerlendirilmiştir. Veriler SPSS 25.0 programı ile analiz edilmiştir.
Bulgular: Çalışmaya 342 kadın ve 58 erkek birey dâhil edilmiştir. Yaş ortalaması 44.95 ± 12.52 yıl olarak hesaplanmıştır. Hipotiroidi hastalarında TSH, anti-TPO ve DBK düzeyleri anlamlı şekilde yüksek; sT4, hemoglobin, B12, MCV, demir ve ferritin düzeyleri anlamlı şekilde düşük bulunmuştur (p<0.001). sT4 ile hematolojik parametreler arasında pozitif; TSH ve anti-TPO ile negatif korelasyon saptanmıştır.
Sonuç: Hipotiroidi hastalarında anemi ve B12 eksiklikleriyle ilişkili hematolojik değişiklikler gözlenmiştir. Bu nedenle, bu hastaların demir ve B12 düzeylerinin düzenli aralıklarla izlenmesi erken tanı ve tedavi açısından önem taşımaktadır.

References

  • 1. Türkiye Endokrinoloji ve Metabolizma Derneği Tiroid Çalışma Grubu. Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu. Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği; 2020 [cites 2025 Oct 17]. Available from: https://file.temd.org.tr/Uploads/publications/guides/documents/20200929134733-2020tbl_kilavuzf527c34496.pdf?a=1
  • 2. Romine MF, Rodionov DA, Maezato Y, Anderson LN, Nandhikonda P, Rodionova IA, et al. Elucidation of roles for vitamin B12 in regulation of folate, ubiquinone, and methionine metabolism. Proc Natl Acad Sci U S A. 2017;114(7):E1004-13.
  • 3. Oymak Y, İlhan G. Türk Hematoloji Derneği. Eritrosit hastalıkları ve hemoglobin bozuklukları tanı ve tedavi kılavuzu. Sürüm 1.1. İstanbul: Türk Hematoloji Derneği; 2019. [cited 2025 Oct 17]. Available from: https://thd.org.tr/thdData/userfiles/file/Ertitrosit-Tani-ve-tedavi-Kilavuzu-2019.pdf
  • 4. Zhang Y, Xue Y, Cao C, Huang J, Hong Q, Hai T, et al. Thyroid hormone regulates hematopoiesis via the TR-KLF9 axis. Blood. 2017;130(20):2161-70.
  • 5. Antonijević N, Nesović M, Trbojević B, Milosević R. Anemia in hypothyroidism. Med Pregl. 1999;52(3-5):136-40.
  • 6. Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. Am Fam Physician. 2012;86(3):244-51.
  • 7. Golde DW, Bersch N, Chopra IJ, Cline MJ. Thyroid hormones stimulate erythropoiesis in vitro. Br J Haematol. 1977;37(2):173-7. 8. Hu S, Rayman MP. Multiple nutritional factors and the risk of Hashimoto’s thyroiditis. Thyroid. 2017;27(5):597-610. 9. Zhang HY, Teng XC, Shan ZY, Wang ZJ, Li CY, Yu XH, et al. Association between iron deficiency and prevalence of thyroid autoimmunity in pregnant and non-pregnant women of childbearing age: a cross-sectional study. Chin Med J (Engl). 2019;132(18):2143-9.
  • 10. Szczepanek-Parulska E, Hernik A, Ruchała M. Anemia in thyroid diseases. Pol Arch Intern Med. 2017;127(5):352-60.
  • 11. Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923-31.
  • 12. Kim M, Kim BH, Lee H, Jang MH, Kim JM, Kim EH, et al. Association between serum free thyroxine and anemia in euthyroid adults: a nationwide study. Endocrinol Metab (Seoul). 2020;35(1):106-14. 13. van Vliet NA, Kamphuis AEP, Den Elzen WPJ, Blauw GJ, Gussekloo J, Noordam R, et al. Thyroid function and risk of anemia: a multivariable-adjusted and Mendelian randomization analysis in the UK Biobank. J Clin Endocrinol Metab. 2022;107(2):495-502.
  • 14. Lippi G, Montagnana M, Salvagno GL, Guidi GC. Should women with abnormal serum thyroid stimulating hormone undergo screening for anemia? Arch Pathol Lab Med. 2008;132(3):321-2. 15. Bashboosh NN. Correlation between hypothyroidism and iron deficiency anemia in female patients. World J Pharm Pharm Sci. 2017;6(1):80-9.
  • 16. Erdoğan M, Kosenli A, Ganıdagli S, Kulaksizoglu M. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocr J. 2012;59(3):213-20.
  • 17. Shetty A, Chowdappa V. Cytomorphological spectrum of Hashimoto’s thyroiditis and its correlation with hormonal profile and hematological parameters. J Cytol. 2019;36(3):137-43.
  • 18. Banday T, Bhat S, Bhat S, Shah N, Bashir S. To study prevalence of incipient iron deficiency in primary hypothyroidism. Int J Res Med Sci. 2014;2(2):472-6.
  • 19. Maldonado-Araque C, Valdés S, Lago-Sampedro A, Lillo-Muñoz JA, Garcia-Fuentes E, Perez-Valero V, et al. Iron deficiency is associated with hypothyroxinemia and hypotriiodothyroninemia in the Spanish general adult population: Di@bet.es study. Sci Rep. 2018;8(1):5118.
  • 20. Dahiya K, Verma M, Dhankhar R, Ghalaut VS, Ghalaut PS, Sachdeva A, et al. Thyroid profile and iron metabolism: mutual relationship in hypothyroidism. Indian J Endocrinol Metab. 2016;20(1):16-22.
  • 21. Jabbar A, Yawar A, Wasim S, Islam N, Ul Haque N, Zuberi L, et al. Vitamin B12 deficiency common in primary hypothyroidism. J Pak Med Assoc. 2008;58(5):258-61.
  • 22. Verma S, Thakur RK, Beg A, Sahoo SS, Mishra J, Trisal M. Vitamin B12 deficiency in subclinical hypothyroid: a pilot study. J Pharm Negat Results. 2022;13(7):2427-33.
  • 23. Khatiwada S, Gelal B, Baral N, Lamsal M. Association between iron status and thyroid function in Nepalese children. Thyroid Res. 2016;9(1):2.
There are 19 citations in total.

Details

Primary Language English
Subjects Health Services and Systems (Other)
Journal Section Articles
Authors

Burcu Güler 0009-0006-2592-5941

Tijen Acar 0000-0002-3200-8926

Publication Date October 29, 2025
Submission Date May 26, 2025
Acceptance Date September 29, 2025
Published in Issue Year 2025 Volume: 17 Issue: 3

Cite

APA Güler, B., & Acar, T. (2025). Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients with Primary Hypothyroidism. Konuralp Medical Journal, 17(3), 281-286. https://doi.org/10.18521/ktd.1706390
AMA Güler B, Acar T. Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients with Primary Hypothyroidism. Konuralp Medical Journal. October 2025;17(3):281-286. doi:10.18521/ktd.1706390
Chicago Güler, Burcu, and Tijen Acar. “Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients With Primary Hypothyroidism”. Konuralp Medical Journal 17, no. 3 (October 2025): 281-86. https://doi.org/10.18521/ktd.1706390.
EndNote Güler B, Acar T (October 1, 2025) Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients with Primary Hypothyroidism. Konuralp Medical Journal 17 3 281–286.
IEEE B. Güler and T. Acar, “Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients with Primary Hypothyroidism”, Konuralp Medical Journal, vol. 17, no. 3, pp. 281–286, 2025, doi: 10.18521/ktd.1706390.
ISNAD Güler, Burcu - Acar, Tijen. “Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients With Primary Hypothyroidism”. Konuralp Medical Journal 17/3 (October2025), 281-286. https://doi.org/10.18521/ktd.1706390.
JAMA Güler B, Acar T. Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients with Primary Hypothyroidism. Konuralp Medical Journal. 2025;17:281–286.
MLA Güler, Burcu and Tijen Acar. “Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients With Primary Hypothyroidism”. Konuralp Medical Journal, vol. 17, no. 3, 2025, pp. 281-6, doi:10.18521/ktd.1706390.
Vancouver Güler B, Acar T. Investigation of Hemoglobin, Iron, Ferritin, and Vitamin B12 Levels in Patients with Primary Hypothyroidism. Konuralp Medical Journal. 2025;17(3):281-6.

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