Red Blood Cell indices in patients with hypothyroidism



  • Antony Jose

    Resident in FMMC, Mangalore

  • Peter George

    Professor; Department of General Medicine, Father Muller Medical College, Father Muller Road, Mangaluru 575002


hypothyroidism, red blood cell indices, hemoglobin, thyroid function tests, TFT, PCV, RBC count


Background: Hypothyroidism is a common endocrine disorder in clinical practice. It is known to present with multiple systemic manifestations. As thyroid hormones play an important role in erythropoiesis; dysfunction usually result in hematological abnormalities.

Aim and Objective: To study the RBC indices in hypothyroidism and to differentiate the pattern of anemia in patients on thyroid supplementation.

Materials and methods: This cross-sectional observational study was done among 60 hypothyroid subjects attending to a tertiary care center at Mangalore. Thyroid Function Tests (TFT) and Red Blood Cell indices were obtained and analysed using SPSS software v20.

Results: Among 60 hypothyroid subjects, 54 (90%) were females and 6 (10%) were males. The prevalence of anemia was 60% (n=36); among whom biochemically 14 were euthyroid and 22 had overt hypothyroid status. Among these subjects; 20 had normocytic, 12 had microcytic and 4 had macrocytic anemias. The mean haemoglobin in the study population was 11.91 ± 2.26 g/dl. Statistically significant lower levels of haemoglobin, PCV and RBC count where seen among overt hypothyroids as compared to euthyroids.

Conclusion: Overt hypothyroid subjects had lower hemoglobin, PCV and RBC counts as compared to euthyroids. Early identification and treatment of hypothyroidism could prevent or revert the hematological changes; thus ensuring better quality of life.


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Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87: 489-99.

Aybike K, Mehmet E, Sencer G, Mustafa K, Soner S, Ozgun K, et al. Anemia frequency and etiology in primary hypothyroidism. 2009; Available from: http://www.

Unnikrishnan AG, Kalra S, Sahay RK, Bantwal G, John M, Tewari N. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocrinol Metab 2013; 17: 647-52

Yen PM. Physiological and molecular basis of thyroid hormone action. Physiol Rev 2001; 81(3): 1097-142.

Kawa MP, Grymula K, Paczkowska E, Baśkiewicz-Masiuk M, Dabkowska E, Koziolek M, et al. Clinical relevance of thyroid dysfunction in human haematopoiesis: biochemical and molecular studies. Eur J Endocrinol 2010; 162(2): 295-305.

Cinemre H, Bilir C, Gokosmanoglu F, Bahcebasi T. Hematologic effects of levothyroxine in iron‑deficient subclinical hypothyroid patients: A randomized, double-blind, controlled study. J Clin Endocrinol Metab 2009; 94: 151‑6.

Mahajan AS, Lal R, Dhanwal DK, Jain AK, Chowdhury V. Evaluation of autonomic functions in subclinical hypothyroid and hypothyroid patients. Indian J Endocr Metab 2013; 17: 460-4.

WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organisation (WHO), 2011 (WHO/NMH/NHD/MNM/11.1); Available from:

Golde DW, Bersch N, Chopra IJ, Cline MJ. Thyroid hormones stimulate erythropoiesis in vitro. The British Journal of Haematology 1977; 37(2): 173–7.

Kazemi-Jahromi M, Shahriari-Ahmadi A, Samedanifard S-H, Doostmohamadian S, Abdolahpoor E, Allameh SF. The Association between Hypothyroidism and Anemia: a Clinical Study. International Journal of Hematology-Oncology and Stem Cell Research 2010; 4(3): 6-9.

Saeed AA, Alfaify NM, Alhilali AI, Al-wadaI NW, Shubaili MH, Alasiri SJ et al. Prevalence of Anemia in Hypothyroidism: Systematic Review and Meta-Analysis. EC Microbiology 2019; 15(6): 514-22.

Bremner AP, Feddema P, Joske DJ, Leedman PJ, O’Leary PC, Olynyk JK, et al. Significant association between thyroid hormones and erythrocyte indices in euthyroid subjects. Clin Endocrinol (Oxf) 2012; 76: 304‑11.

Schindhelm RK, Ten BE, Heima NE, van Schoor NM, Simsek S. Thyroid hormones and erythrocyte indices in a cohort of euthyroid older subjects. Eur J Intern Med 2013; 24: 241‑4.

Foster MP, Rodriguez EM, Dorshkind K. Proliferation of bonemarrow pro-B cells is dependent on stimulation by the pituitary/thyroid axis. Journal of Immunology 1999; 163(11): 5883–90.

Anand R, Mishra AK, Mahdi AA, Verma SP, Gupta KK. A study of prevalence and pattern of anemia in primary hypothyroidism. Int J Med Sci Public Health 2018; 7(2): 153-9.

Das C, Sahana PK, Sengupta N, Giri D, Roy M, Mukhopadhyay P. Etiology of anemia in primary hypothyroid subjects in a tertiary care center in Eastern India. Indian J Endocr Metab 2012; 16(2): 361-3.

Patel RP and Jain A. Study of anemia in primary hypothyroidism. Thyroid Research and Practice 2017; 14(1): 22-4.

Mehmet E, Aybike K, Sencer G, Mustafa K. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocrine Journal 2012; 59(3): 213-20.

Kuhr T, Hala K, Dietrich H, Herold M, Wick G. Genetically determined target organ susceptibility in the pathogenesis of spontaneous autoimmune thyroiditis: aberrant expression of MHC-class II antigens and the possible role of virus. J Autoimmune 1994; 7: 13-25.

Christ‑Crain M, Meier C, Huber P, Zulewski H, Staub JJ, Muller B. Effect of restoration of euthyroidism on peripheral blood cells and erythropoietin in women with subclinical hypothyroidism. Hormones (Athens) 2003; 2: 237‑42.

Jabbar A, Yawar A, Wasim S, Islam N, Haque NU, Zuberi L et al. Vitamin B 12 deficiency common in primary hypothyroidism. J Pak Med Assoc 2008; 58(5): 258-61.




How to Cite

Jose A, George P. . Int Jour of Biomed Res [Internet]. 2020 Sep. 30 [cited 2022 Oct. 17];11(8):e5494. Available from:


Vol. 11 No. 8 (2020): Aug


Original Research Articles

Dr. Jun Ren is a dedicated and experienced registered dietitian and nutritionist who is committed to helping people achieve their health goals through personalized nutrition plans. With a passion for promoting healthy eating habits and preventing chronic diseases, Dr. Ren has been able to assist numerous clients in improving their overall quality of life.

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