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Graves' Disease and Microcytic Anemia: A Forgotten Connection.

Fevzi Daldal¹, Andrew Dancis²

¹Department of Biology, University of Pennsylvania, Philadelplhia, PA, USA.

The American Journal of Case Reports

|November 26, 2024

Summary

Thyrotoxicosis can cause microcytic anemia by disrupting red blood cell production. Treatment of hyperthyroidism resolved the anemia, suggesting a direct link between thyroid hormones and red blood cell size.

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Area of Science:

Endocrinology
Hematology

Background:

Microcytic anemia is infrequently associated with thyrotoxicosis, with limited recent literature.
The underlying mechanism for this association remains poorly understood.

Observation:

A 56-year-old man with Graves' disease presented with hyperthyroidism and concurrent microcytic anemia.
Anemia and microcytosis resolved following methimazole treatment for hyperthyroidism.
Iron deficiency was absent, as indicated by normal/high serum ferritin levels, which decreased with treatment.

Findings:

Supraphysiological triiodothyronine (T3) levels induced proteotoxic stress in non-iron-deficient red cell precursors.
This stress activated the integrated stress response, phosphorylating eIF2 and inhibiting globin mRNA translation.
Reduced globin synthesis led to microcytosis, mimicking thalassemia.

Implications:

This study proposes a novel mechanism linking thyrotoxicosis to microcytic anemia via impaired globin synthesis.
The findings highlight the importance of considering thyroid function in unexplained microcytic anemia.
Understanding this mechanism may lead to new diagnostic or therapeutic strategies.