TY - JOUR

T1 - The Relation Between Thyroid Function and Anemia

T2 - A Pooled Analysis of Individual Participant Data

AU - Wopereis, Daisy M

AU - Du Puy, Robert S

AU - van Heemst, Diana

AU - Walsh, John P

AU - Bremner, Alexandra

AU - Bakker, Stephan J L

AU - Bauer, Douglas C

AU - Cappola, Anne R

AU - Ceresini, Graziano

AU - Degryse, Jean

AU - Dullaart, Robin P F

AU - Feller, Martin

AU - Ferrucci, Luigi

AU - Floriani, Carmen

AU - Franco, Oscar H

AU - Iacoviello, Massimo

AU - Iervasi, Georgio

AU - Imaizumi, Misa

AU - Jukema, J Wouter

AU - Khaw, Kay-Tee

AU - Luben, Robert N

AU - Molinaro, Sabrina

AU - Nauck, Matthias

AU - Patel, Kushang V

AU - Peeters, Robin P

AU - Psaty, Bruce M

AU - Razvi, Salman

AU - Schindhelm, Roger K

AU - van Schoor, Natasja M

AU - Stott, David J

AU - Vaes, Bert

AU - Vanderpump, Mark P J

AU - Völzke, Henry

AU - Westendorp, Rudi G J

AU - Rodondi, Nicolas

AU - Cobbaert, Christa M

AU - Gussekloo, Jacobijn

AU - den Elzen, Wendy P J

AU - Thyroid Studies Collaboration

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

U2 - 10.1210/jc.2018-00481

DO - 10.1210/jc.2018-00481

M3 - Journal article

C2 - 30113667

VL - 103

SP - 3658

EP - 3667

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 10

ER -