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Clinical and Subclinical Thyroid Disorders Associated With Pernicious Anemia: Observations on Abnormal Thyroid-Stimulating Hormone Levels and on a Possible Association of Blood Group O With Hyperthyroidism

Clinical and Subclinical Thyroid Disorders Associated With Pernicious Anemia: Observations on... Abstract • Of 162 patients with pernicious anemia whom we studied, 24.1% had clinical thyroid disease; 11.7% were hypothyroid and 8.6% were hyperthyroid. When abnormal serum thyroid-stimulating hormone (TSH) levels were also considered, thyroid disorders existed in 48.3% of 143 patients. Increased or decreased TSH levels as the sole dysfunction occurred in 14.7% and 6.3% of cases, respectively, and were often associated with thyroid antibodies. The high TSH group fits the picture of subclinical hypothyroidism. The nature of the low TSH group remains to be defined. We conclude that TSH screening in patients with pernicious anemia uncovers frequent abnormalities, which are superimposed on a higher coincidence of overt thyroid disease than previously described. Interestingly, also, eight of nine hyperthyroid patients and all seven patients with low TSH levels had blood type O, contrasting significantly with hypothyroid subjects, who more often had blood type A, and with patients without thyroid disorders. (Arch Intern Med 1982;142:1465-1469) References 1. Tudhope GR: The Thyroid and the Blood . London, Heinemann Medical Books, 1969, pp 37-64. 2. Irvine WJ: The association of atrophic gastritis with autoimmune thyroid disease. Clin Endocrinol Metabol 1975;4:351-377.Crossref 3. Chanarin I: The Megaloblastic Anaemias , ed 1. Oxford, England, Blackwell Scientific Publications, 1969, pp 505-506. 4. Carmel R, Johnson CS: Racial patterns in pernicious anemia: Early age at onset and increased frequency of intrinsic-factor antibody in black women. N Engl J Med 1978;298:647-650.Crossref 5. Spencer CA, Nicoloff JT: Improved radioimmunoassay for human TSH. Clin Chim Acta 1980;108:415-424.Crossref 6. Carmel R, Ozturk G, Johnson CS, et al: Profiles of black and Latin-American patients having pernicious anemia: HLA antigens, lymphocytotoxic antibody, anti-parietal cell antibody, serum gastrin levels and ABO blood groups. Am J Clin Pathol 1981;75:291-296. 7. Evered DC, Ormston BJ, Smith PA, et al: Grades of hypothyroidism. Br Med J 1973;1:657-662.Crossref 8. Hall R, Ormston BJ, Besser GM, et al: The thyrotropin-releasing hormone test in diseases of the pituitary and hypothalamus. Lancet 1972;1:759-762.Crossref 9. Gottlieb C, Lau KS, Wasserman LR, et al: Rapid charcoal assay for intrinsic factor (IF), gastric juice unsaturated B12 binding capacity, antibody to IF, and serum unsaturated B12 binding capacity. Blood 1965;25:875-884. 10. Nie N, Hull CH, Jenkins J, et al: Statistical Package for the Social Sciences , ed 2. New York, McGraw-Hill Book Co, 1975. 11. Mourant AE, Kopec AC, Domaniewska-Sobczak K: The Distribution of the Human Blood Groups and Other Polymorphisms , ed 2. London, Oxford University Press, 1976, pp 203-206. 12. Furszyfer J, Kurland LT, McConahey WM, et al: Epidemiologic aspects of Hashimoto's thyroiditis and Graves' disease in Rochester, Minnesota (1935-1967), with special reference to temporal trends. Metabolism 1972;21:197-204.Crossref 13. Brown J, Solomon DH, Beall GN, et al: Autoimmune thyroid disease: Graves' and Hashimoto's. Ann Intern Med 1978;88:379-391.Crossref 14. Wong ET, Bradley SG, Schultz AL: Elevations of thyroid-stimulating hormone during acute nonthyroidal illness. Arch Intern Med 1981;141:873-875.Crossref 15. Gordin A, Saarinen P, Pelkonen R, et al: Serum thyrotrophin and the response to thyrotrophin-releasing hormone in symptomless autoimmune thyroiditis and in borderline and overt hypothyroidism. Acta Endocrinol 1974;75:274-285. 16. Gordin A, Lamberg BA: Natural course of symptomless autoimmune thyroiditis. Lancet 1975;2:1234-1238.Crossref 17. Fowler PBS, Daly JR: Natural course of symptomless autoimmune thyroiditis. Lancet 1976;1:247-248.Crossref 18. Nilsson G, Nordlander S, Levin K: Studies on clinical hypothyroidism with special reference to the serum lipid pattern. Acta Med Scand 1976;200:63-67.Crossref 19. Editorial: Thyroiditis, autoimmunity and coronary risk factors. Lancet 1977;2:173-175. 20. Tunbridge WMG, Brewis M, French JM, et al: Natural history of autoimmune thyroiditis. Br Med J 1981;1:258-262.Crossref 21. Doniach D, Roitt IM, Taylor KB: Autoimmune phenomena in pernicious anaemia: Serological overlap with thyroiditis, thyrotoxicosis and systemic lupus erythematosus. Br Med J 1963;1:1374-1379.Crossref 22. Ozturk G, Terasaki PI: Non-HLA lymphocyte cytotoxins in various diseases. Tissue Antigens 1979;14:52-58.Crossref 23. Harrison GA, Boyce JA, Hornabrook RW, et al: Evidence for an association between ABO blood groups and goitre. Hum Genet 1976;32:335-337.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Clinical and Subclinical Thyroid Disorders Associated With Pernicious Anemia: Observations on Abnormal Thyroid-Stimulating Hormone Levels and on a Possible Association of Blood Group O With Hyperthyroidism

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340210057014
Publisher site
See Article on Publisher Site

Abstract

Abstract • Of 162 patients with pernicious anemia whom we studied, 24.1% had clinical thyroid disease; 11.7% were hypothyroid and 8.6% were hyperthyroid. When abnormal serum thyroid-stimulating hormone (TSH) levels were also considered, thyroid disorders existed in 48.3% of 143 patients. Increased or decreased TSH levels as the sole dysfunction occurred in 14.7% and 6.3% of cases, respectively, and were often associated with thyroid antibodies. The high TSH group fits the picture of subclinical hypothyroidism. The nature of the low TSH group remains to be defined. We conclude that TSH screening in patients with pernicious anemia uncovers frequent abnormalities, which are superimposed on a higher coincidence of overt thyroid disease than previously described. Interestingly, also, eight of nine hyperthyroid patients and all seven patients with low TSH levels had blood type O, contrasting significantly with hypothyroid subjects, who more often had blood type A, and with patients without thyroid disorders. (Arch Intern Med 1982;142:1465-1469) References 1. Tudhope GR: The Thyroid and the Blood . London, Heinemann Medical Books, 1969, pp 37-64. 2. Irvine WJ: The association of atrophic gastritis with autoimmune thyroid disease. Clin Endocrinol Metabol 1975;4:351-377.Crossref 3. Chanarin I: The Megaloblastic Anaemias , ed 1. Oxford, England, Blackwell Scientific Publications, 1969, pp 505-506. 4. Carmel R, Johnson CS: Racial patterns in pernicious anemia: Early age at onset and increased frequency of intrinsic-factor antibody in black women. N Engl J Med 1978;298:647-650.Crossref 5. Spencer CA, Nicoloff JT: Improved radioimmunoassay for human TSH. Clin Chim Acta 1980;108:415-424.Crossref 6. Carmel R, Ozturk G, Johnson CS, et al: Profiles of black and Latin-American patients having pernicious anemia: HLA antigens, lymphocytotoxic antibody, anti-parietal cell antibody, serum gastrin levels and ABO blood groups. Am J Clin Pathol 1981;75:291-296. 7. Evered DC, Ormston BJ, Smith PA, et al: Grades of hypothyroidism. Br Med J 1973;1:657-662.Crossref 8. Hall R, Ormston BJ, Besser GM, et al: The thyrotropin-releasing hormone test in diseases of the pituitary and hypothalamus. Lancet 1972;1:759-762.Crossref 9. Gottlieb C, Lau KS, Wasserman LR, et al: Rapid charcoal assay for intrinsic factor (IF), gastric juice unsaturated B12 binding capacity, antibody to IF, and serum unsaturated B12 binding capacity. Blood 1965;25:875-884. 10. Nie N, Hull CH, Jenkins J, et al: Statistical Package for the Social Sciences , ed 2. New York, McGraw-Hill Book Co, 1975. 11. Mourant AE, Kopec AC, Domaniewska-Sobczak K: The Distribution of the Human Blood Groups and Other Polymorphisms , ed 2. London, Oxford University Press, 1976, pp 203-206. 12. Furszyfer J, Kurland LT, McConahey WM, et al: Epidemiologic aspects of Hashimoto's thyroiditis and Graves' disease in Rochester, Minnesota (1935-1967), with special reference to temporal trends. Metabolism 1972;21:197-204.Crossref 13. Brown J, Solomon DH, Beall GN, et al: Autoimmune thyroid disease: Graves' and Hashimoto's. Ann Intern Med 1978;88:379-391.Crossref 14. Wong ET, Bradley SG, Schultz AL: Elevations of thyroid-stimulating hormone during acute nonthyroidal illness. Arch Intern Med 1981;141:873-875.Crossref 15. Gordin A, Saarinen P, Pelkonen R, et al: Serum thyrotrophin and the response to thyrotrophin-releasing hormone in symptomless autoimmune thyroiditis and in borderline and overt hypothyroidism. Acta Endocrinol 1974;75:274-285. 16. Gordin A, Lamberg BA: Natural course of symptomless autoimmune thyroiditis. Lancet 1975;2:1234-1238.Crossref 17. Fowler PBS, Daly JR: Natural course of symptomless autoimmune thyroiditis. Lancet 1976;1:247-248.Crossref 18. Nilsson G, Nordlander S, Levin K: Studies on clinical hypothyroidism with special reference to the serum lipid pattern. Acta Med Scand 1976;200:63-67.Crossref 19. Editorial: Thyroiditis, autoimmunity and coronary risk factors. Lancet 1977;2:173-175. 20. Tunbridge WMG, Brewis M, French JM, et al: Natural history of autoimmune thyroiditis. Br Med J 1981;1:258-262.Crossref 21. Doniach D, Roitt IM, Taylor KB: Autoimmune phenomena in pernicious anaemia: Serological overlap with thyroiditis, thyrotoxicosis and systemic lupus erythematosus. Br Med J 1963;1:1374-1379.Crossref 22. Ozturk G, Terasaki PI: Non-HLA lymphocyte cytotoxins in various diseases. Tissue Antigens 1979;14:52-58.Crossref 23. Harrison GA, Boyce JA, Hornabrook RW, et al: Evidence for an association between ABO blood groups and goitre. Hum Genet 1976;32:335-337.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1982

References