Evaluation of increased serum ferritin levels in patients with hyperthyroidism

Kubota, Keiichi; Tamura, Jun’ichi; Kurabayashi, H; Shirakura, Takuo; Kobayashi, Ieyoshi

doi:10.1007/bf00231112

Cited by 18 publications

(8 citation statements)

References 10 publications

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“…Presumably, the male group size was too small to achieve similar observations. This is consistent with previous research, where ferritin concentration was increased in hyperthyroid subjects and returned to the normal range after antithyroid therapy (25). The authors suggested that the increase in serum ferritin level in hyperthyroidism may be explained by the direct action of thyroid hormones on its synthesis or accompanying impaired iron utilization.…”

Section: Discussionsupporting

confidence: 91%

Changes in serum hepcidin according to thyrometabolic status in patients with Graves’ disease

Krygier

Szczepanek‐Parulska

Filipowicz

et al. 2020

Endocrine Connections

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Introduction:Hepcidin is an acute-phase protein and a key regulator of iron homeostasis. Anaemia frequently occurs in patients with thyroid dysfunction, and hepcidin may be a potential link. Objectives: Prospective assessment of hepcidin serum concentration and other parameters related to Fe homeostasis in hyperthyroid patients in the course of GD at diagnosis and during remission. Patients and Methods: Out of the 70 patients recruited, 42 (32 women, 10 men), aged 42.5 ± 15.1 years, met the inclusion criteria. Clinical and biochemical assessment, including hepcidin measurement by ELISA, was performed at baseline (T0) and after restoration of euthyroidism (T1). Results: Hepcidin concentration at T0 in the 24 patients who completed the study was significantly higher than the value during euthyroidism (28.7 (8.1-39.4) ng/mL vs 7.9 (4.3-12.9) ng/mL, P < 0.001). Hepcidin level was most significantly correlated with ferritin (rho = 0.723) in women at T0. In both men (377 (171-411) vs 165 (84-237) ng/mL, P = 0.001) and women (84 (23-104) vs 35 (16-64) ng/mL, P = 0.001), a significant decrease in ferritin level was demonstrated following therapy. A significant (P < 0.001) increase in mean corpuscular volume (MCV) (83.5 (82.5-87.1) vs 89.5 (88.8-90.0) fL) and mean concentration of haemoglobin (MCH) (29.0 (28.0-29.4) vs 30.4 (29.5-31.1) pg) was observed. Conclusions: Hepcidin and ferritin decrease significantly during the transition from a hyperthyroid state to euthyroidism in patients with GD. The observed changes occur in parallel to iron homeostasis fluctuations. During the transition from the hyperthyroid state to euthyroidism, the improvement of haematological status is reflected mainly by the increase in MCV and MCH. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Section: Discussionsupporting

confidence: 91%

Changes in serum hepcidin according to thyrometabolic status in patients with Graves’ disease

Krygier

Szczepanek‐Parulska

Filipowicz

et al. 2020

Endocrine Connections

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“…Several groups have reported that T 3 positively regulates serum ferritin in humans (Macaron & Macaron 1982, Van de Vyver et al 1982, Takamatsu et al 1985, Hashimoto & Matsubara 1989, Kubota et al 1993, Barnum-Huckins & Adrian 2000. Elevated serum ferritin levels were observed in hyperthyroid individuals, and levels decreased significantly after antithyroid treatment which helped to normalize T 3 levels (Macaron & Macaron 1982, Van de Vyver et al 1982, Takamatsu et al 1985, Kubota et al 1993, Barnum-Huckins & Adrian 2000.…”

Section: Discussionmentioning

confidence: 99%

“…Elevated serum ferritin levels were observed in hyperthyroid individuals, and levels decreased significantly after antithyroid treatment which helped to normalize T 3 levels (Macaron & Macaron 1982, Van de Vyver et al 1982, Takamatsu et al 1985, Kubota et al 1993, Barnum-Huckins & Adrian 2000. Furthermore, administration of T 3 to hypothyroid individuals produced a significant increase in the serum ferritin level (Takamatsu et al 1985, Hashimoto & Matsubara 1989.…”

Section: Discussionmentioning

confidence: 99%

Plasma protein regulation by thyroid hormone

Kh¹,

Hy²,

Ch³

et al. 2003

Journal of Endocrinology

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Thyroid hormones (THs) regulate growth, development, differentiation and metabolic processes by interacting and activating thyroid hormone receptors (TRs). Although much progress has been made in our understanding of the transcriptional regulation of many TR target genes, little is known of the regulation of plasma protein gene expression by TRs. To investigate the role of TRs in plasma protein expression we used human hepatocellular carcinoma cell lines and carried out cDNA microarray analysis. Our results indicate that several plasma proteins including transferrin, prothrombin, angiotensinogen, haptoglobin, -2-HS-glycoprotein and chain, complement, lipoproteins and fibrinogen are up-regulated by THs. Furthermore, clusterin, -2-macroglobulin precursor, prothymosin and -fetoprotein were found to be down-regulated by THs.Transferrin, an iron-binding protein expressed in all mammals, and mainly synthesized in the liver, was investigated further. Immunoblot and Northern blot analyses revealed that exposure of HepG2-TR 1 sub-lines and HepG2-Neo cells to tri-iodothyronine (T 3 ) induced time-and dose-dependent increases in the abundance of transferrin mRNA and protein, with the extent of these effects correlating with the level of expression of TR 1. Nuclear run-on experiments indicate that this induction is functioning at the transcriptional level. Moreover, cyclohexamide treatment did not eliminate the induction of transferrin by TH. Thus, our results suggest that the induction of transferrin by TH is direct and may in fact be mediated by an as yet unidentified response element in the promoter region.

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“…SHBG levels are usually elevated in thyrotoxicosis and have been reported to be normal in a few patients with generalized resistance to thyroid hormone (GRTH) [5,6]. Also, a significant body of evidence exists showing a positive correlation between the serum levels of T 3 , T 4 and ferritin [7,8] in patients with abnormal thyroid status. Namely, all of these studies documented elevated serum ferritin levels in patients with hyperthyroidism which normalized when the T 3 and T 4 levels returned to normal.…”

Section: Discussionmentioning

confidence: 99%

Case report: When measured free T4 and free T3 may be misleading. Interference with free thyroid hormones measurements on Roche® and Siemens® platforms

2012

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A 59-year old female patient presented with apathy and 6 kg weight gain. Investigations revealed severe primary hypothyroidism (TSH>100 μIU/ml). L-thyroxine (L-T4) was started and titrated up to 75 μg, once daily, with clinical improvement. Other investigations revealed very high titres of anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies. After three months, there was a fall in TSH to 12.74 μIU/ml, however, with unexpectedly high free T4 (FT4) - 6.8 ng/ml and free T3 (FT3) - 6.7 pg/ml concentrations [reference range (rr): 0.8-1.9 ng/ml and 1.5-4.1 pg/ml (Siemens®), respectively]. At this stage L-T4 was stopped, and this was followed by a rapid increase in TSH (to 77.76 μIU/ml) and some decrease in FT4 and FT3, however FT4 concentration remained elevated (2.1 ng/ml). Following this, L-T4 was restarted. On admission to our Department, she was clinically euthyroid on L-T4, 88 μg, once daily. Investigations on Roche® platform confirmed mildly elevated TSH - 5.14 (rr: 0.27-4.2 μIU/ml) with high FT4 [4.59 (rr: 0.93-1.7 ng/ml)] and FT3 [4.98 (rr: 2.6-4.4 pg/ml)] concentrations. Other tests revealed hypoechogenic ultrasound pattern typical for Hashimoto thyroiditis. There was no discrepancy in calculated TSH value following TSH dilution (101% recovery). Concentrations of FT4 and FT3 were assessed on the day of discontinuation of L-T4 and after four days by the means of Abbott® Architect I 1000SR platform. These revealed FT4 and FT3 concentrations within the reference range [e.g., FT4 - 1.08 ng/ml (rr: 0.7-1.48)] vs 4.59 ng/ml (rr: 0.93-1.7, Roche®), FT3 - 3.70 pg/ml (rr: 1.71-3.71) vs 4.98 (rr: 2.6-4.4, Roche®)], confirming assay interference. Concentrations of ferritin and SHBG were normal.ConclusionsClinicians must be aware of possible assay interference, including the measurements of FT4 and FT3 in the differential diagnosis of abnormal results of thyroid function tests that do not fit the patient clinical presentation.

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Evaluation of increased serum ferritin levels in patients with hyperthyroidism

Cited by 18 publications

References 10 publications

Changes in serum hepcidin according to thyrometabolic status in patients with Graves’ disease

Changes in serum hepcidin according to thyrometabolic status in patients with Graves’ disease

Plasma protein regulation by thyroid hormone

Case report: When measured free T4 and free T3 may be misleading. Interference with free thyroid hormones measurements on Roche® and Siemens® platforms

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