TYPE AND NATURE OF ANEMIAS DEPENDING ON THE TYPE OF THYROID DYSFUNCTION

Abstract

Relevance. Anemia is a frequent concomitant condition in thyroid dysfunction (THD) and significantly affects the course of the underlying disease, the quality of life of patients and the effectiveness of treatment. Thyroid hormone deficiency leads to a decrease in erythropoiesis, impaired metabolism of iron, folic acid and vitamin B-12, while thyrotoxicosis may be accompanied by an increased destruction of erythrocytes and functional iron deficiency. Insufficient attention to the relationship between the type of thyroid dysfunction and the nature of anemia complicates the timely diagnosis and correction of these conditions. In this regard, the study of the types and characteristics of anemias depending on the functional state of the thyroid gland is relevant for optimizing diagnostic and treatment tactics and improving the prognosis of patients. The aim of the study was to determine the type and nature of anemia depending on the type of thyroid dysfunction in adults and adolescents.

Materials and methods. The study included 97 adults and 28 adolescents with thyroid dysfunction. Adults were divided into 3 groups depending on thyroid pathology: group 1 - hypothyroidism on the background of autoimmune thyroiditis (n = 33, 34.02%, median age 47 [38; 57] years), group 2 - postoperative hypothyroidism (n = 33, 34.02%, median age 48 [43; 55] years), group 3 - DTZ, thyrotoxicosis (n = 31, 31.96%, median age 51 [49; 54] years). Among adolescents, 2 groups were formed depending on the existing thyroid dysfunction: group 1 – hypothyroidism on the background of autoimmune thyroiditis (n=16, 57.14%, median age 14 [11.8; 15.3] years) and group 2 – DTZ, thyrotoxicosis (n=12, 42.86%, median age 12 [10.8; 15.3] years). All patients were tested for levels of thyroid-stimulating hormone (TSH), thyroxine (T4), antibodies to thyroid peroxidase (ATTPO), antibodies to thyroglobulin (ATTG), hepcidin, ferritin, vitamin B-12 and folic acid.

Results. In our study, the iron deficiency anemia (IDA) was more common in boys than in girls: 76.92% (51.25-94.83%) versus 60.00% (35.00-82.49%), p=0.049. Among the adult patients, significant gender differences were found in the presence of B12 deficiency anemia (B12-DA): the proportion of men was significantly higher among adult patients with B12-DA - 39.74% (29.22-50.77%), p=0.02. There were no significant gender differences in adolescents. Adults with folate deficiency anemia (FDA) had significantly more frequent DTZ, thyrotoxicosis (38.96% (28.43-50.04%), p=0.004), while in patients without FDA, hypothyroidism on the background of autoimmune thyroiditis prevailed (55.00% (33.42-75.64%), p=0.03). FDA was also significantly more frequently detected in older patients (88.31% (80.24-94.48%), p=0.04).

Conclusions. Iron deficiency anemia was more frequently diagnosed in boys (76.92% (51.25-94.83%), p=0.049), while no gender differences were found in adults. B12 deficiency anemia in adults was more frequently observed in men, and in adolescents there were no significant differences by gender. Folate deficiency anemia was more frequently associated with diffuse toxic goiter/thyrotoxicosis and older age in adults. The results emphasize the importance of an individualized approach to the prevention and treatment of anemias, taking into account age, gender, and thyroid status.