Treat Blood Issues in Sub-clinical Hypothyroidism

[helvella]

In the recent past we have seen many people post here with questionable red blood cell (erythrocyte) test results – usually as a part of a standard (and relatively inexpensive) Full Blood Count. This paper appears to back up what has been repeated many times here: identify and treat these issues. Note particularly that these blood issues are present in sub-clinical hypothyroidism and that is the subject of the paper. Overt hypothyroidism is surely unlikely to be of any less significance?

They specifically mention forms of anaemia (iron-deficiency and pernicious are possibly the most obvious forms – but also possible from low folates, and other causes) – all should be appropriately treated.

We keep writing about B12, iron/ferritin, folate, vitamin D – our “usual suspects” or ”fab five” or whatever other term might be applied to them. Good to get a paper so clearly backing up most of them.

(In addition to the relatively simple issues presented here, all sorts of other changes occur in the blood of people with thyroid disorders. These include changes to platelets and clotting factors, acquired von Willebrand disease, and others.)

I would also like to make a point that this paper is available because Iran and India (or maybe people and organisations within those countries rather than governments) seem to think it should be. It is very sad that so many papers produced in other countries, including the UK, are behind paywalls with impossibly high costs of access to ordinary mortals.

Here is the PubMed abstract:

Med J Islam Repub Iran. 2012 Nov;26(4):172-178.

Comparison of hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients.

Bashir H, Bhat MH, Farooq R, Majid S, Shoib S, Hamid R, Mattoo AA, Rashid T, Bhat AA, Wani HA, Masood A.

Source

MSc, MPhil, Department of biochemistry, GMC, Srinagar, Kashmir, India. [e-mail].

Abstract

BACKGROUNDS:

Thyroid hormones play an important physiological role in human metabolism. Erythrocyte abnormalities are frequently associated with thyroid disorder. However, they are rarely investigated and related to the subclinical and primary hypothyroidism in Kashmiri Patients. In this study an attempt was made to study hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients.

METHODS:

This retrospective study included 600 subjects, among which were untreated subclinical hypothyroid (n=110), treated subclinical hypothyroid (n=110), untreated primary hypothyroid (n=100), treated primary hypothyroid (n=100) and euthyroid (n=180). This study was carried out at Department of Biochemistry, Government Medical College Srinagar. The hematological parameters and thyroid profile of the subjects were assessed by the Sysmex (Italy) and ECLIA (Germany) 2010 automatic analyzer. Mean, standard deviation (SD), analysis of variance (Two-way ANOVA), and multiple comparisons were used to report our results, with p<0.05 or p<0.01 considered as statistically significant.

RESULTS:

In this study group we compared the hematological parameters in these groups, untreated subclinical hypothyroid, treated subclinical hypothyroid, untreated primary hypothyroid, treated primary hypothyroid and euthyroid. We found that hematological parameters like Hb, RBC, MCV, HCT, RDW,RBC% were significantly increased in untreated subclinical hypothyroidism and untreated primary hypothyroidsm, with the p value being less than 0.05 whereas, in treated SCH & Pr. Hypothyroid, results were insignificant. The results reported in these groups as mean±SD, were statistically tested by ANOVA and multiple comparison tests. In untreated subclinical hypothyroid the values were: Hb (10.83±1.33 g/dl), RBC (4.21±0.66 106/µl), MCV (84.56±6.84 fL), HCT (38.5±2.2%), RDW (17.91±2.37 fL), RBC% (84.36±13.2%) and in untreated primary hypothyroid, Hb (10.73±0.86 g/dl), RBC (4.63±0.51 106/µl), MCV (83.34±6.92 fL), HCT (38.6±2.6%), RDW (14.93±5.47 fL), RBC% (92.63±10.30%) suggesting that these patients were at risk of anemia and other erythrocyte abnormalities. MCV is an inexpensive approach to study the types of anemia and explore related information like production, destruction, loss and morphological changes of RBC'S.

CONCLUSION:

The thyroid dysfunction is frequently associated with anemia in subclinical hypothyroidism and primary hypothyroidism. Subclinical hypothyroidism (SCH) is associated with serious complications. Substantial numbers of patients with the risk of SCH could be getting converted into primary hypothyroidism. Such conditions should be identified and corrected. On the other hand, their presence could move to a thyroid dysfunction, allowing its early management.

KEYWORDS:

Blood count, Hemoglobin, Mean corpuscular volume, Primary hypothyroidism, Red cell distribution, Subclinical hypothyroidism

PMID: 23482519 [PubMed - as supplied by publisher]

ncbi.nlm.nih.gov/pubmed/234...

The full paper is available as a PDF from here:

mjiri.tums.ac.ir/browse.php...

While looking around, I also found an interesting link to Anemia of Endocrine Disorders:

medtextfree.wordpress.com/2...

Rod

Picture is of two (normal!) red blood cells – the one on the left is oxygenated; the one on the right is deoxygenated.

[Merkaba]

Many thanks for posting and although not yet had opportunity to visit the links I certainly will do. I have autoimmune thyroiditis with episodes of hyperthyroidism and extremely unwell with severe symptoms for 3 years even when TSH/FT4 shows normal - presumably caused by antibodies. Not had a full blood count since late 2011 but prior to this when full blood counts done I questioned why RDW; MCV and Lymphocytes were not normal but doctors not concerned and never given any explanations.

Thanks again as most interesting.

Isis x

[wakeham]

Hi Rod,

Just received my blood count back to-day perhaps you could look at them,GP done them to see if I had inflamation in my back as I have a lot of pain in my back and legs! he said all is fine so I don't know.

Haemoglobin estimation 12.4 g/dL 12.00 - 16.00g/dL

white cell count 7.3 10*9/L 4.00 -11.00 10*9/L

Platelet count 270 10*9/L 150.00 - 400.00 10*9/L

Red blood cell (RBC) 4.1 10*12/L 4.00 - 5.8010*12/L

Heamatocrit 37% 35.00 - 48.00%

Mean corpuscular volume (MCV) 89 fl 80.00 - 99.00fl

Mean corpus heamoglobin (MCH) 30.2 pg 27.00 - 32.00pg

Mean corpus.Hb.conc.(MCHC) 33.9 g/dL 30.00 - 34.00g/dL

! Red blood cell distribut width 11% 12.00 - 16.00%

Neutrophil count 3.2 10*9/L 2.00 -7.0010*9/L

Lymphocyte count 3.2 10*9/L 1.00 - 4.0010*9/L

Monocyte count 0.6 10*9/L 0.20 - 1.0010*9/L

Eosinophil count 0.3 10*9/L 0.10 - 0.6010*9/L

I have Low Iron,B12 and Vit D so are supplementing them all myself as GP would not help!

Hope you don't mind me asking you.I shall read the links that you posted thank you to see if they help to explain more about blood situation to me as it is confusing at times.

Thank you in anticipation wakeham.

[helvella Administrator Thyroid UK in reply to wakeham]

I don't mind you asking, but I am feeling ignorant. Partly that is how am I at this moment. Nothing is leaping out as very wrong. Obviously not everything is quite right - but it is not clear to me what the answers are. Maybe you are going in the right direction.

Anyone else care to dive in?