Anemia: A Cause of Intolerance to Thyroxine Sodium

This might be fifteen years old, but I cannot remember seeing it posted here! (Occasional repetition isn't such a bad thing either.)

Am well aware that getting iron deficiency anaemia resolved is a mantra round here. Nice to see such a simpe statement.

Anemia: A Cause of Intolerance to Thyroxine Sodium

Capt K.M. Mohamed Shakir, MC, USNcorrespondence

, Capt David Turton, MC, USN

, Capt (SEL) Brian S. Aprill, MC, USN

, Capt (SEL) Almond J. Drake III, MC, USN

, Radm John F. Eisold, MC, USN

Department of Internal Medicine, National Naval Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Md

Usual causes of intolerance to thyroxine sodium include coronary artery disease, advanced age, untreated adrenal insufficiency, and severe hypothyroidism. We describe 4 patients with iron deficiency anemia and primary hypothyroidism. After treatment with thyroxine sodium, these patients developed palpitations and feelings of restlessness, which necessitated discontinuation of the thyroid hormone. After the anemia was treated with ferrous sulfate for 4 to 7 weeks, they were able to tolerate thyroxine sodium therapy. Iron deficiency anemia coexisting with primary hypothyroidism results in a hyperadrenergic state. In such patients, we postulate that thyroid hormone administration causes palpitations, nervousness, and feelings of restlessness. Correction of any existing pronounced anemia in hypothyroid patients who are intolerant to thyroxine sodium therapy may result in tolerance to this agent.

Happily, full text is available here:

mayoclinicproceedings.org/a...

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7 Replies

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  • Nice find!

    This is the kind of post I am likely to want to find again to point out to others who come along later. Could it be put into the topic of Research Papers instead of Hypothyroidism please.

    The Hypothyroidism topic is just a big lump of posts that can't be searched and useful stuff gets lost.

  • Oh - OK - just for you.

  • Thank you. :D

  • This is a keeper - what we've felt & being saying for ages.... low Iron & palps...

    ta Rodders :)

  • Im hypo and anemic and have been for 2 years having heart flip flops. Had the thyroxine damagrd my heart im confused?

  • No.

    What the paper is saying is that people who are given Levothyroxine while they are also suffering from iron-deficiency anaemia will often develop palpitations and won't be able to tolerate the Levo very well (or at all).

    To solve the problem, the patient's iron deficiency needs to be treated for a few weeks. If the patient is then started on Levo again they often cope with it much better.

  • Thankyou. I ask because my rhyroid leveks were uo and down being poorly monitored. I have since found a great endocrinologist. My ferritin kevel is 14 and have had on and off anemia all my life but last 2 yrs has been bad. My heart flip floos slowed down could thay have been from too much thyroid meds and iron not being treated ? Also i still get them not as bad they hive me panic and anxiety so bad actually make me not want to leave my home. I never felt palps like this before when i had low iron though. Thoughts? Xx thankyou anyone who replys

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