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Meta-Analysis
. 2018 Oct 1;103(10):3658-3667.
doi: 10.1210/jc.2018-00481.

The Relation Between Thyroid Function and Anemia: A Pooled Analysis of Individual Participant Data

Daisy M Wopereis  1   2 , Robert S Du Puy  1 , Diana van Heemst  2 , John P Walsh  3   4 , Alexandra Bremner  5 , Stephan J L Bakker  6 , Douglas C Bauer  7   8 , Anne R Cappola  9 , Graziano Ceresini  10 , Jean Degryse  11   12 , Robin P F Dullaart  6 , Martin Feller  13   14 , Luigi Ferrucci  15 , Carmen Floriani  13 , Oscar H Franco  16 , Massimo Iacoviello  17 , Georgio Iervasi  18 , Misa Imaizumi  19 , J Wouter Jukema  20 , Kay-Tee Khaw  21 , Robert N Luben  21 , Sabrina Molinaro  22 , Matthias Nauck  23 , Kushang V Patel  24 , Robin P Peeters  16   25 , Bruce M Psaty  26   27 , Salman Razvi  28 , Roger K Schindhelm  29 , Natasja M van Schoor  30 , David J Stott  31 , Bert Vaes  11   12 , Mark P J Vanderpump  32 , Henry Völzke  33 , Rudi G J Westendorp  34 , Nicolas Rodondi  13   14 , Christa M Cobbaert  35 , Jacobijn Gussekloo  1   2 , Wendy P J den Elzen  35 ; Thyroid Studies Collaboration
Affiliations
Meta-Analysis

The Relation Between Thyroid Function and Anemia: A Pooled Analysis of Individual Participant Data

Daisy M Wopereis et al. J Clin Endocrinol Metab. .

Abstract

Context: Anemia and thyroid dysfunction often co-occur, and both increase with age. Human data on relationships 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 OR 1.84 (95% CI 1.35 to 2.50), subclinical hypothyroidism 1.21 (1.02 to 1.43), subclinical hyperthyroidism 1.27 (1.03 to 1.57), and overt hyperthyroidism 1.69 (1.00 to 2.87)]. Hemoglobin levels were lower in all groups compared with 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 to 2.20) for overt hypothyroidism, 1.18 (1.00 to 1.38) for subclinical hypothyroidism, 1.15 (0.94 to 1.42) for subclinical hyperthyroidism, and 1.47 (0.91 to 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 participants with both 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.

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Figures

Figure 1.
Figure 1.
The pooled ORs of the risk of having anemia at baseline with the 95% CI and P value for trend. Logistic regression models corrected for age and sex; reference group is euthyroidism.
Figure 2.
Figure 2.
The pooled hazard ratios of developing anemia during follow-up in the thyroid function groups with the 95% CI and P value for trend. Cox regression models corrected for age and sex; reference group is euthyroidism.
See this image and copyright information in PMC

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