Could Red Cell Distribution Width be a Marker in Hashimoto's Thyroiditis?

[helvella]

Red Cell Distribution Width is a measure of the range of sizes of red blood cells which is usually included in a modern, automated blood testing machine. We should have our red blood cells in a tight band of sizes with few small or large cells. If we are suffering from two issues - one that makes cells smaller (e.g. iron deficiency anaemia) and one that makes them larger (e.g. pernicious anaemia) we often see an increase in the range of sizes - which is shown as a higher RDW number.

This paper suggests that in people with no other known reason for having a high RDW, seeing an elevated RDW could indicate Hashimoto's.

The second paper says similar but is a few years old.

Exp Clin Endocrinol Diabetes. 2014 Nov;122(10):572-4. doi: 10.1055/s-0034-1383564. Epub 2014 Nov 7.

Could Red Cell Distribution Width be a Marker in Hashimoto's Thyroiditis?

Aktas G1, Sit M2, Dikbas O3, Tekce BK4, Savli H1, Tekce H1, Alcelik A1.

Abstract

AIMS:

Hashimoto's Thyroiditis (HT) is the most common autoimmune thyroiditis worldwide and characterized with lymphomonocytic inflammation of the thyroid gland. Red cell distribution width (RDW) reflects erythrocyte anisocytosis and besides it increases in iron deficiency anemia, recent studies reported that RDW was also associated with conditions characterized with overt or subclinical inflammation. We aimed to answer whether RDW increased in Hashimoto's thyroiditis.

METHODS:

Patients with HT admitted to outpatient clinic of our hospital were included to the study. Patients with anemia (especially iron deficiency), diabetes mellitus, chronic inflammatory disease and on medication that may affect hemogram results (e. g., aspirin) excluded from the study. Patient characteristics, thyroid stimulating hormone (TSH), Free T3 (FT3), Free T4 (FT4), Anti-thyroid peroxidase (Anti-TPO), Anti-Thyroglobulin (Anti-TG), leukocyte count (WBC), Hemoglobin (Hb), Hematocrit (Htc), mean corpuscular volume (MCV), RDW and platelet count (PLT) values of the study cohort were obtained from computerized database of our institution.

RESULTS:

There was no significant difference between study and control groups in terms of WBC, Hb, Htc, MCV, PLT, PDW and FT3 levels. However, FT4 level was significantly lower and TSH was significantly higher in study group compared to controls. RDW was significantly increased in study group compared to control group.

CONCLUSION:

We suggest that elevated RDW values in patients without iron deficiency anemia may require further evaluation for HT, especially in female population.

© Georg Thieme Verlag KG Stuttgart · New York.

PMID:

25380549

[PubMed - in process]

ncbi.nlm.nih.gov/pubmed/253...

biomedscidirect.com/486/rol...

This is a heavyweight article on the meaning of RDW:

emedicine.medscape.com/arti...

This link includes a short section on RDW - which seems to say that it should be left to haematology to interpret. Which would be fine if results with elevated RDW were actually sent to haematology for interpretation!

patient.co.uk/doctor/full-b...

Rod

[humanbean]

I've had an FBC done by the NHS several times over the last few years, and not once was my RDW ever measured. So the NHS makes sure they reduce the cost of diagnosing several health problems by making sure they never have the evidence.

[helvella Administrator Thyroid UK in reply to humanbean]

Am a bit surprised - thought most labs now did it!

For example:

pathology.stgeorges.nhs.uk/...

and

pathology.leedsth.nhs.uk/pa...

However, when I looked a bit further afield, I did find labs that don't include it as part of FBC. I suspect it will depend on the machine used - I'd hope that when they replace it at some point, the new machine might include RDW.

Rod

[j5lt in reply to helvella]

This is very interesting. My FBC is considered 'normal' yet the RDW is 14.4 (range 11-14) and marked as 'abnormal' I've asked GP what this means and was told it wasn't relevant. I will now be researching all these links further, very helpful thank you.

[helvella Administrator Thyroid UK in reply to j5lt]

From what I gather, RDW has only been readily available since the introduction of fairly sophisticated computerised analysis equipment. Maybe doctors who qualified some years ago simply did not get taught about it and have never picked up on it.

I do have some sympathy in that as soon as you look, you might have to go further to accurately identify the causes. That might well be beyond GPs for many reasons.

Rod