Characterization of the anaemia associated with Graves' disease.
BACKGROUND
Graves' disease (GD) is associated with hyperthyroidism. Thyrotoxicosis adversely affects multiple organ systems including haematopoiesis. Anaemia occurring specifically in GD has not been systematically studied previously.


OBJECTIVE
To define the prevalence and characteristics of the anaemia associated with GD.


METHODS
Eighty-seven newly diagnosed patients with GD were recruited. Haematological indices, thyroid function and inflammatory parameters were examined at presentation and following successful treatment of hyperthyroidism.


METHODS
Tertiary care academic referral centre.


RESULTS
Thirty-three per cent of subjects presented with anaemia. The prevalence of anaemia not attributable to other causes (GD anaemia) was 22%. GD anaemia affected 41.6% (10/24) of men compared to 17.5% of women (11/63). Mean erythropoietin (EPO) levels (15.5 +/- 5.3 mIU/ml) were within normal reference limits but significantly higher (P = 0.004) than those of the non-anaemic controls. Hgb correlated inversely with EPO (P = 0.05) and CRP (P = 0.04) levels, a relationship that persisted after multivariate adjustment for TT3 or TT4. With antithyroid therapy for 16 +/- 6.3 weeks, Hgb levels normalized in 8 out of 9 subjects with GD anaemia (10.7 +/- 0.8 to 13.5 +/- 1.3 g/dl, P = 0.0001). After normalization of Hgb, mean MCV and TIBC were significantly increased, and median ferritin and mean EPO were significantly decreased.


CONCLUSIONS
GD anaemia is common, resembles the anaemia of chronic disease, and is associated with markers of inflammation. It corrects promptly with return to the euthyroid state following treatment.
Gianoukakis
Andrew G
AG
Division of Molecular Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA. agianouk@ucla.edu
Leigh
Mary J
MJ
Richards
Patrick
P
Christenson
Peter D
PD
Hakimian
Aliza
A
Fu
Paul
P
Niihara
Yutaka
Y
Smith
Terry J
TJ
D000328:Adult; D000740:Anemia / Q000097:blood* / Q000209:etiology*; D013956:Antithyroid Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D004909:Erythrocyte Indices; D004921:Erythropoietin / Q000097:blood; D005260:Female; D005293:Ferritins / Q000097:blood; D006111:Graves Disease / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013963:Thyroid Hormones / Q000097:blood; D013971:Thyrotoxicosis / Q000097:blood / Q000150:complications / Q000188:drug therapy; D055815:Young Adult
D013956:Antithyroid Agents; D001323:Autoantibodies; D006454:Hemoglobins; D018836:Inflammation Mediators; D013963:Thyroid Hormones; D004921:Erythropoietin; D002097:C-Reactive Protein; D005293:Ferritins