Volume 22, Issue 4 (9-2019)                   J Arak Uni Med Sci 2019, 22(4): 124-133 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Shiravand Z, Talaei A. Effect of Iron on Thyroid Function in Women With Hypothyroidism: A Double-blind Clinical Trial Study. J Arak Uni Med Sci 2019; 22 (4) :124-133
URL: http://jams.arakmu.ac.ir/article-1-6091-en.html
1- Department of Internal Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran.
2- Department of Internal Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran. , afsanehtalaeii@yahoo.com
Full-Text [PDF 2383 kb]   (1562 Downloads)     |   Abstract (HTML)  (2286 Views)
Full-Text:   (33044 Views)
1. Introduction
Hypothyroidism is a systemic disease affecting all organs [1]. Research has shown that thyroid hormone imbalance in hypothyroid patients is associated with anemia in these patients. Iron deficiency, on the other hand, can lead to a defect in thyroid hormone synthesis by reducing thyroid peroxidase activity [2-4]. Since hypothyroidism and iron deficiency are common in women, and iron deficiency can also be effective in many hormonal processes, treatment of anemia is needed to improve the response to hypothyroidism. Untreated anemia has irreparable consequences. On the other hand, iron therapy can improve thyroid function and even reduce the dose of levothyroxine drug. Therefore, this study aimed to investigate the effect of iron supplementation on thyroid function.
2. Materials and Methods
In this randomized clinical trial study, 94 women with hypothyroidism under treatment with levothyroxine were selected by a simple sampling method and randomly divided into the intervention and control groups. After obtaining informed consent from the patients, their T3, T4, and TSH (thyroid-stimulating hormone) levels and the iron profile (hemoglobin, serum iron, transferrin, ferritin) were measured and recorded. Then, the patients in the intervention group received levothyroxine with iron (100 mg oral per day), and the control group received levothyroxine plus a placebo for 2 months. After two months, the T3, T4, and TSH levels and the iron profile were again measured in both groups, and the results of before and after the treatment were compared. The SPSS V. 19 was used for data analysis.
3. Results
Table 1 compares thyroid hormone levels of the study patients before and after the intervention. The results showed that the mean level of T3 and T4 in the intervention group increased significantly, but the level of TSH decreased significantly. The results of statistical analysis showed that the mean difference of T3, T4, and TSH between the intervention and control groups was significant (P<0.05) (Table 2).

4. Discussion
The results of this study showed that the prevalence of iron deficiency anemia in patients with hypothyroidism was 42.6% (40 out of 94), which is higher than the normal population (15%). Also, adding 100 mg oral ferrous sulfate daily for 2 months results in a decrease in serum TSH levels and an increase in T3 and T4, in other words, improvement of thyroid hormones in women with hypothyroidism. On the other hand, a significant increase in serum iron, hemoglobin, and ferritin levels and a decrease in total iron-binding capacity also indicate that this amount of iron is effective in improving serum iron levels. That is to say, concomitant administration of iron with levothyroxine in patients with hypothyroidism leads to a decrease in TSH and improvement of laboratory parameters and response to treatment.
Ethical Considerations
Compliance with ethical guidelines

The study was approved by the Research Ethics Committee of Arak University of Medical Sciences (Code:1396154) and is a registered clinical trial (Code: IRCT20151114025031).
The present paper was extracted from the PhD. thesis of the first author, Zahra Shiravand, approved by Department of Internal Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran.
Authors' contributions
All authors have met the standards of writing criteria based on the recommendations of the International Committee of Medical Journal Publishers (ICMJE).
Conflicts of interest
The authors declared no conflicts of interest.
The authors would like to thank the authorities of Arak University of Medical Sciences for their cooperation in conducting this research.

  1. Brenner B, Fandrey J, Jelkmann W, Serum immunoreactive erythropoietin in hyper- d hypothyroidism: Clinical observations related to cell culture studies. Eur J Haematol. 1994; 53(1):6-10. [DOI:10.1111/j.1600-0609.1994.tb00171.x]
  2. Metwalley K, Farghaly H, Hassan A. Thyroid function in egyptian primary school children with iron deficiency anemia: Relationship to intellectual function. J Thyroid Res. 2013; 10(3):91-5. [DOI:10.4103/0973-0354.116131]
  3. Akhter S, Nahar Z, Parvin S, Alam A, Sharmin S, Arslan M, Thyroid status in patients with low serum ferritin level. Bangladesh J Biochem. 2013; 5(1):5-11. [DOI:10.3329/bjmb.v5i1.13424]
  4. Beard J, Brigham D, Kelley S, Green M. Plasma thyroid hormone kinetics are altered in irondeficient rats. J Nutr. 1998; 128(8):1401-8. [DOI:10.1093/jn/128.8.1401]
  5. Ravanbod M, Asadipooya K, Kalantarhormozi M, Nabipour I, Omrani G. Treatment of irondeficiency anemia in patients with subclinical hypothyroidism. Am J Med. 2013; 126(5):420-4. [DOI:10.1016/j.amjmed.2012.12.009]
  6. Rezvani M, Malek F, Ghotaslou A, Kamali M. [Investigation of relation between iron deficiency anemia and hypothyroidism (Persian)]. Razi J Med Sci. 2016; 23(149):89-97.
  7. Dahiya K, Verma M, Dhankhar R, Ghalaut V, Ghalaut P. Thyroid profile and iron metabolism: Mutual relationship inhypothy roidism. Biomed Res. 2016; 27(4):1212-5.
  8. Rostaei N, Vakili M., Zavar-reza J, Rezaie S, Shirvani AR. The relationship between thyroid hormone levels and body iron status in iranian hypothyroidism patients. Int J Med Lab. 2016; 3(3):176-84.
  9. Eftekhari M, Eshraghian M, Mozafari khosravi H, Saadat N. The effect of iron deficiency compensation on thyroid gland in Iranian adolescent girls suffering from iron deficiency. Pak J Biol Sci. 2007; 15(10):255-60. [DOI:10.3923/pjbs.2007.255.260]
  10. Kazemi M, Shahriairi A, Samedanifrard S, Abdolapoor E, Allameh F. The association between hypothyroidism and anemia: A clinical study. Int J Hematol Oncol Stem Cell Res. 2010; 4(3):6-9.
  11. Gökdeniz E, Demin C, Dilek I. The effects of iron deficiency anemia on the thyroid functions. J Cli Exp Investig. 2010; 1(3):156-60. [DOI:10.5799/ahinjs.01.2010.03.0033]
  12. Duntas L, Papanastasiou L, Mantzou E, Koutras D. Incidence of sideropenia and effects of iron repletion treatment in women with subclinical hypothyroidism. Exp Clin Endocrinol Diabetes. 1999; 107(06):356-60. [DOI:10.1055/s-0029-1212126]
  13. 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 Cli Endocrinol Metabol. 2009; 94(1):151-6. [DOI:10.1210/jc.2008-1440]
  14. Dillman ER, Gale CH, Green WI, Johnson DG, Mackler BR, Finch CL. Hypothermia in iron deficiency due to altered triiodothyronine metabolism. Am J Physiol-Regul Integr Comp Physiol. 1980; 239(5): 377-8. [DOI:10.1152/ajpregu.1980.239.5.R377]
  15. Hess SY, Zimmermann MB, Arnold M, Langhans W, Hurrell RF. Iron deficiency anemia reduces thyroid peroxidase activity in rats. J Nutr. 2002; 132(7):1951-5. [DOI:10.1093/jn/132.7.1951]
  16. Tang F, Wong TM, Loh TT. Effects of cold exposure or TRH on the serum TSH levels in the iron-deficient rat. Horm and Metab Res. 1988; 20(10):616-9. [DOI:10.1055/s-2007-1010899]
  17. El-Masry H, Hamed AM, Hassan MH, Fayed HM, Abdelzaher MH. Thyroid function among children with iron deficiency anaemia: Pre and post iron replacement therapy. J Cli Diagn Res. 2018; 12(1):1-5. [DOI:10.7860/JCDR/2018/32762.11023]
  18. Rezaie S, Shirvani AR. The relationship between thyroid hormone levels and body iron status in iranian hypothyroidism patients. Int J Med Lab. 2016; 3(3):176-84.
  19. Zeltser ME, Mezinova NN, Kobzar NN, Bazarbekova RB, Nazyrov AT, Kim GG, et al. [Thyroid status in anemic pregnant women under conditions of endemic goiter (Russian)]. Probl Endokrinol (Mosk). 1994; 40(5):20-2.
  20. Brzostek J. Concentration of thyroxine, triiodothyronine and thyrotropin in blood serum of children with goitre living in the region of Debica. Przegl Lek. 1996; 53(3):150-4.
  21. Florentino RF, Tanchoco CC, Rodriguez MP, Cruz AJ. Interactions among micronutrients deficiencies and undernutritions in the Philippines. Asia Pacific Clinl Nutr. 1996; 5(3):175-80.
  22. Zimmermann M, Adou P, Torresani T, Zeder C, Hurrell R. Iron supplementation in goitrous, iron-deficient children improves their response to oral iodized oil. Eur J Endocrinol. 2000; 142(1):217-23. [DOI:10.1530/eje.0.1420217]
  23. Ipek I, Kaçmaz E, Bozaykut A, Sezer RJ, Seren L, Paketçi C. The effect of iron deficiency anaemia on plasma thyroid hormone levels in childhood. Turk Arch Ped. 2011; 46:122-5.
  24. Campbell NR, Hasinoff BB, Stalts H, Rao B, Wong NC. Ferrous sulfate reduces thyroxine efficacy in patients with hypothyroidism. Ann Intern Med. 1992; 117(12):1010-3. [DOI:10.7326/0003-4819-117-12-1010]
  25. Park SM, Chatterjee VK. Genetics of congenital hypothyroidism. J Medi Genet. 2005; 42(3):379-8. [DOI:10.1136/jmg.2004.024158]
  26. Nascimento AC, Guedes DR, Santos CS, Knobel M, Rubio IG, Medeiros-Neto G, Thyroperoxidase genemutations in congenital goitrous hypothyroidism with total and partial iodide organification defect. Thyroid. 2003; 13(12):1145-51. [DOI:10.1089/10507250360731550]
  27. Kimura S, Hong YS, Kotani T, Ohtaki S, Kikkawa F. Structure of the human thyroid peroxidase gene: Comparison and relationship to the human myeloperoxidase gene. Biochem. 1989; 28(10):4481-9. [DOI:10.1021/bi00436a054]
  28. Holtorf K. Peripheral thyroid hormone conversion and its impact on TSH and metabolic activity. J Restor Med. 2014; 3(1):30-52. [DOI:10.14200/jrm.2014.3.0103]
  29. Murakawa H, Bland CE, Willis WT, Dallman PR. Iron deficiency and neutrophil function: Different rates of correction of the depressions in oxidative burst and myeloperoxidase activity after iron treatment. Blood. 1987; 69(5):1464-8. [PMID]
  30. Ackrell BA, Maguire J, Dallman PR, Kearney EB. Effect of iron deficiency on succinate and NADH-ubiquinone oxidoreductases in skeletal muscle mitochondria. J Biol Chem. 1984; 259(16):10053-9. [DOI:10.1515/9783111521350-041]
Type of Study: Original Atricle | Subject: Internal
Received: 2019/06/10 | Accepted: 2019/08/24

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2023 CC BY-NC 4.0 | Journal of Arak University of Medical Sciences

Designed & Developed by : Yektaweb