Iron deficiency in women with thyroid-specific autoantibodies: A case control study

Abstract

Autoimmune thyroid diseases are multifaceted conditions in which the thyroid gland is infiltrated by lymphocytes, resulting in the production of thyroid-specific auto-antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TGAb). Iron deficiency is a common nutritional deficiency and has multiple adverse effects on thyroid metabolism. The association between iron status and thyroid autoimmunity has not been well-evaluated. This retrospective study aimed to determine whether the frequency of iron deficiency was higher in patients with thyroid autoimmunity than in healthy individuals with negative thyroid autoantibodies. One-hundred-and-eighty female patients with positive thyroid auto-antibodies and 81 healthy controls were involved in the study. Hemoglobin, hematocrit, mean corpuscular volume (MCV), iron, thyrotropin (TSH), TPOAb, TGAb, free-T4, vitamin B12, ferritin and transferrin saturation (TS) were recorded. TSH, TPOAb and TGAb levels were significantly higher, while hemoglobin, hematocrit, MCV, ferritin, iron and TS were significantly lower in the patient group (all, p<0.05). Patients with thyroid autoimmunity had significantly higher frequency of lower levels of hemoglobin, iron, ferritin, MCV and TS than healthy controls (all, p<0.005). Correlations were found inversely between TPOAb and serum ferritin, iron, and TS levels, and also positively between TGAb and creatinine levels in the patient group. In conclusion, we found increased prevalence of iron deficiency in female patients with thyroid autoimmunity. Patients with autoimmune thyroid diseases were found to be at higher risk of iron deficiency development.

Keywords

• anti-thyroglobulin antibody
• anti-thyroid peroxidase antibody
• ferritin
• hemoglobin
• iron

References

1. 1. Ashraf TS, De Sanctis V, Yassin M, Wagdy M, Soliman N. Chronic anemia and thyroid function. Acta Bio Medica: Atenei Parmensis. 2017;88(1):119. 2. Buzduga CM, Costea CF, Dumitrescu GF, Turliuc MD, Bogdănici CM, Cucu A, et al. Cytological, histopathological and immunological aspects of autoimmune thyroiditis: a review. Rom J Morphol Embryol. 2017;58(3):731-8.
2. 3. Cammack R, Wrigglesworth JM, Baum H. Iron-dependent enzymes in mammalian systems: CRC Press: Boca Raton; 1990.
3. 4. Carvalho DP, Dupuy C. Thyroid hormone biosynthesis and release. Molecular and cellular endocrinology. 2017;458:6-15.
4. 5. Choi CW, Lee J, Park KH, Yoon SY, Choi IK, Oh SC, et al. Prevalence and characteristics of anemia in the elderly: cross-sectional study of three urban Korean population samples. American journal of hematology. 2004;77(1):26-30.
5. 6. Duntas LH. Environmental factors and thyroid autoimmunity. Annales d'endocrinologie; 2011; 72: (2) 108-113.
6. 7. Erdal M, Sahin M, Hasimi A, Uckaya G, Kutlu M, Saglam K. Trace element levels in hashimoto thyroiditis patients with subclinical hypothyroidism. Biological trace element research. 2008;123(1-3):1.
7. 8. Fayadat L, Niccoli-Sire P, Lanet J, Franc J-L. Role of heme in intracellular trafficking of thyroperoxidase and involvement of H2O2 generated at the apical surface of thyroid cells in autocatalytic covalent heme binding. Journal of Biological Chemistry. 1999;274(15):10533-8.
8. 9. Haapala A, Hyöty H, Parkkonen P, Mustonen J, Soppi E. Antibody reactivity against thyroid peroxidase and myeloperoxidase in autoimmune thyroiditis and systemic vasculitis. Scandinavian journal of immunology. 1997;46(1):78-85.

9. 10. Hu S, Rayman MP. Multiple nutritional factors and the risk of Hashimoto's thyroiditis. Thyroid. 2017;27(5):597-610.
10. 11. Hu X, Teng X, Zheng H, Shan Z, Li J, Jin T, et al. Iron deficiency without anemia causes maternal hypothyroxinemia in pregnant rats. Nutrition research. 2014;34(7):604-12.
11. 12. Kawicka A, Regulska-Ilow B. Metabolic disorders and nutritional status in autoimmune thyroid diseases. Advances in Hygiene & Experimental Medicine/Postepy Higieny i Medycyny Doswiadczalnej. 2015;69.
12. 13. Levi M, Simonetti M, Marconi E, Brignoli O, Cancian M, Masotti A, et al. Gender differences in determinants of iron-deficiency anemia: a population-based study conducted in four European countries. Annals of Hematology. 2019;98(7):1573-82.
13. 14. 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. Scientific reports. 2018;8(1):1-7.
14. 15. Percy L, Mansour D, Fraser I. Iron deficiency and iron deficiency anaemia in women. Best practice & research Clinical obstetrics & gynaecology. 2017;40:55-67.
15. 16. Ranendra K, Sarada N. A Study on Anti Thyroid Peroxidase and Anti Thyroglobulin antibodies in patients with Thyroid Dysfunction. Journal of Dental and Medical Sciences 2020; 1(10): 14-18.
16. 17. Ragusa F, Fallahi P, Elia G, Gonnella D, Paparo SR, Giusti C, et al. Hashimotos’ thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6):101367.
17. 18. Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proceedings of the Nutrition Society. 2019;78(1):34-44.
18. 19. Ruggeri R, Trimarchi F, Giuffrida G, Certo R, Cama E, Campennì A, et al. Autoimmune comorbidities in Hashimoto’s thyroiditis: different patterns of association in adulthood and childhood/adolescence. Eur J Endocrinol. 2017;176(2):133-41.
19. 20. Sherard GB 3rd, Newton ER. Is routine hemoglobin and hematocrit testing on admission to labor and delivery needed? Obstetrics and gynecology. 2001;98(6):1038-40.
20. 21. Smith SM, Johnson PE, Lukaski HC. In vitro hepatic thyroid hormone deiodination in iron-deficient rats: effect of dietary fat. Life sciences. 1993;53(8):603-9.
21. 22. Szczepanek-Parulska E, Hernik A, Ruchała M. Anemia in thyroid diseases. Pol Arch Intern Med. 2017;127(5):352-60.
22. 23. Veltri F, Decaillet S, Kleynen P, Grabczan L, Belhomme J, Rozenberg S, et al. Prevalence of thyroid autoimmunity and dysfunction in women with iron deficiency during early pregnancy: is it altered. Eur J Endocrinol. 2016;175(3):191-9.
23. 24. Wang Y-P, Lin H-P, Chen H-M, Kuo Y-S, Lang M-J, Sun A. Hemoglobin, iron, and vitamin B12 deficiencies and high blood homocysteine levels in patients with anti-thyroid autoantibodies. Journal of the Formosan Medical Association. 2014;113(3):155-60.
24. 25. Zhang Y, Huang X, Chen Z, Yang Q, Li X, Zhang R, et al. Iron defıcıency, a rısk factor for thyroıd autoımmunıty durıng second trımester of pregnancy ın Chına. Endocrine Practice. 2020;26:(6). 595-603.