ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

The Effect of Treatment of Iron Deficiency Anemia on Thyroid Volume
Demir Eksikliği Tedavisinin Tiroid Volümü Üzerine Etkisi
Received Date : 09 Jul 2018
Accepted Date : 22 Dec 2018
Doi: 10.25179/tjem.2018-62120 - Makale Dili: EN
Turk J Endocrinol Metab 2019;23:38-46
ABSTRACT
Objective: Iron and iodine, which are the two important micronutrients, are still deficient in a large number of women worldwide. This study aimed to examine the thyroid volumes of iron deficient, anemic women before and after correction of the anemia in a mildly iodine deficient environment. Material and Methods: Sixty six women aged 18-45 years were prospectively enrolled in this study. Inclusion criteria included serum hemoglobin (Hb) level <11.0 g/dL, ferritin level <13 ng/mL, thyroid hormones within normal reference ranges and negative thyroid antibodies. Oral iron supplement (567 mg ferrous sulfate, twice a day) for six months was prescribed and strongly recommended. All patients were re-evaluated at the end of the iron treatment. Results: Initially, the median (minimum/maximum) Hb and ferritin levels of patients were 10.2 g/dL (5.6/11.1) and 3.95 ng/mL (0.44/10.7), respectively. Six months later, median Hb and ferritin values increased significantly to 13.15 g/dL (9.3/15.6) (p<0.001) and 19.575 ng/mL (3.74/79) (p<0.001) respectively. Median thyroid volume decreased significantly from 15.705 mL (7.15/54.2) to 13.212 mL (6.11/52.8) (p<0.001). The patients were grouped according to the improvements in Hb and ferritin levels, initial thyroid gland volume, and response to the treatment. The reduction in thyroid gland size, at the end of the treatment, was more significant in patients with improvement in both Hb and ferritin levels as compared to those with improvement only in Hb levels (p<0.05). Conclusion: Iron may be responsible for efficient organification of iodine, active iodine utilization from thyroglobulin, and control of hyperkinetic blood-flow to the thyroid gland. The findings of this study support that other than iodine, iron supplementation has a significant effect on the regression of thyroid volume in women with iron deficiency anemia.
ÖZET
Amaç: Demir ve iyot, iki önemli mikro besin olup, dünya genelinde yaygın olarak kadınlarda hâlen eksiklikleri görülmektedir. Bu çalışmada, hafif iyot eksikliği bölgesindeki demir eksikliği anemisi bulunan kadınların, aneminin düzelmesinden önce ve sonra tiroid volümlerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya; yaş aralığı 18-45 yıl olan, 66 kadın hasta katılmıştır. Çalışmaya dâhil edilme kriterleri; serum hemoglobin (Hb) düzeyi <11,0 g/dL, ferritin düzeyi <13 ng/mL, tiroid hormonlarının normal sınırlarda ve tiroid antikorlarının negatif olması olarak belirlenmiştir. Her hastaya ağızdan demir desteği (567 mg ferrous sülfat, günde iki kez) reçete edilmiş ve kuvvetle önerilmiştir. Tüm hastalar demir tedavisi sonrası yeniden değerlendirilmiştir. Bulgular: Başlangıçta hastaların medyan (minimum/maksimum) Hb ve ferritin düzeyleri sırasıyla, 10,2 g/dL (5,6/11,1) ve 3,95 ng/mL (0,44/10,7) idi. Altı ay sonra, Hb düzeyleri 13,15 g/dL (9,3/15,6) (p<0,001) ve ferritin düzeyleri 19,575 ng/mL (3,74/79) (p<0,001) ile anlamlı artış gösterdi. Medyan (minimum/maksimum) tiroid volümü de tedavi öncesi 15,705 mL (7,15/54,2) iken, tedavi sonrası 13,212 mL (6,11/52,8) (p<0,001) ile anlamlı azalma gösterdi. Hastalar ayrıca, Hb ve ferritin değerindeki iyileşmeye, tedavi başlangıcındaki tiroid bezi büyüklüğüne ve tedavi yanıtına gore karşılaştırıldılar. Tedavi sonunda tiroid bezi volümündeki gerileme, Hb ve ferritin değerinde iyileşme gösterenlerde, yalnız Hb değeri düzelenlere göre daha belirgin idi (p<0,05). Sonuç: Demir; iyotun etkin organifikasyonundan, tiroglobinde iyotun etkin kullanımından, tiroid bezinin hiperkinetik kan akımının kontrolünden sorumlu olabilmektedir. Çalışmamız da demir eksikliği anemisi olan kadınlarda, demir tedavisinin, artmış tiroid volümünün düzelmesine belirgin katkısı olduğunu desteklemektedir.
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