The relation between thyroid function and anemia: a pooled analysis of individual participant data.
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BORIS DOI
Date of Publication
October 1, 2018
Publication Type
Article
Division/Institute
Contributor
Wopereis, Daisy M | |
Du Puy, Robert S | |
van Heemst, Diana | |
Walsh, John P | |
Bremner, Alexandra | |
Bakker, Stephan J L | |
Bauer, Douglas C | |
Cappola, Anne R | |
Ceresini, Graziano | |
Degryse, Jean | |
Dullaart, Robin P F | |
Ferrucci, Luigi | |
Franco, Oscar H | |
Iacoviello, Massimo | |
Iervasi, Georgio | |
Imaizumi, Misa | |
Jukema, J Wouter | |
Khaw, Kay-Tee | |
Luben, Robert N | |
Molinaro, Sabrina | |
Nauck, Matthias | |
Patel, Kushang V | |
Peeters, Robin P | |
Psaty, Bruce M | |
Razvi, Salman | |
Schindhelm, Roger K | |
van Schoor, Natasja M | |
Stott, David J | |
Vaes, Bert | |
Vanderpump, Mark P J | |
Völzke, Henry | |
Westendorp, Rudi G J | |
Cobbaert, Christa M | |
Gussekloo, Jacobijn | |
den Elzen, Wendy P J |
Series
Journal of clinical endocrinology and metabolism
ISSN or ISBN (if monograph)
0021-972X
Publisher
Endocrine Society
Language
English
Publisher DOI
PubMed ID
30113667
Description
Context
Anemia and thyroid dysfunction often co-occur and both increase with age. Human data on the relationship 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 odds ratio 1.84 [95% CI: 1.35-2.50], subclinical hypothyroidism 1.21 [1.02-1.43], subclinical hyperthyroidism 1.27 [1.03-1.57], overt hyperthyroidism 1.69 [1.00-2.87]). Hemoglobin levels were lower in all groups compared to 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: 0.86-2.20] for overt hypothyroidism, 1.18 [1.00-1.38] for subclinical hypothyroidism, 1.15 [0.94-1.42] for subclinical hyperthyroidism and 1.47 [0.91-2.38] 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 both participants with 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.
Anemia and thyroid dysfunction often co-occur and both increase with age. Human data on the relationship 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 odds ratio 1.84 [95% CI: 1.35-2.50], subclinical hypothyroidism 1.21 [1.02-1.43], subclinical hyperthyroidism 1.27 [1.03-1.57], overt hyperthyroidism 1.69 [1.00-2.87]). Hemoglobin levels were lower in all groups compared to 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: 0.86-2.20] for overt hypothyroidism, 1.18 [1.00-1.38] for subclinical hypothyroidism, 1.15 [0.94-1.42] for subclinical hyperthyroidism and 1.47 [0.91-2.38] 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 both participants with 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.