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From: "Steve Harris" <>
Subject: Re: Low Thyroid and Anemia?
Date: Fri, 19 Apr 2002 22:17:06 -0600
Message-ID: <a9qq60$4da$>

"ednakyrie" <> wrote in message
> "CBI" <> wrote in message
> > "ednakyrie" <> wrote in message
> >
> > > "                 MS" <> wrote in message
> >  news:<>..
> > > > Any connection between hypothyroidism and anemia?
> > > There can be.  Broda Barnes thought it was to do with low temperature
> > > (the main red cell producing bones were too cold to make red blood
> > > cells) - he writes about it in Hypothyroidism:Thge Unsuspected
> > > Illness.
> > > There's also an interesting bit in the 'For Doctors Only Chapter of
> > > Solved:The Riddle of Illness by Stephen Langer.
> > > I haven't got that much on an anemia on my site but you might find it
> > > interesting -
> > > best wishes, Edna Kyrie
> >
> > Contrary to popular belief, oral temperatures of 97 and even 96
> > degrees are not abnormal and do not reflect thryoid disease. Also low
> > temperature is not a common feature of hypothyroidism. I must admit
> > that I do not know why hypothyoidism causes anemia but I am fairly
> > certain that it has little to do with body temperature.
> You are making a very stong statement regarding temperature.  Could
> you please post the research it is based on?
> Edna Kyrie


Before you all have this argument, please define your terms. There is
hypothyroidism defined by high TSH, but this is often "subclinical" (no
symptoms) so long as T4s are in normal range, and almost always is
subclinical for TSH's < 10. Symptoms, when they occur, are so mild and
nonspecific, and so submerged in the common and chronic and usually NOT
thyroid related problems of our society (weight gain, high cholesterol,
fatigue) that it's difficult to prove that they are changed by treatment
(though treating does raise people's anxiety levels-- surprise). I'll append
two recent double blind studies which looked at this, with conflicting
results. I believe one of the studies is the first ever to claim to document
positive results of treating high TSH's-- the other found nothing (as have
previous studies). Jury is out until we have more studies. Until then, high
TSH with normal T4s is treated mainly so that everyone can quit worrying
about it progressing to full low-T4 clinical hypothyroidism with clear
symptoms. So the doc can quit worrying, that is. Expect the patient to have
more worries about everything. Thyroid is essentially "speed," remember.

I don't think you can find me any data that body temperature is changed in
"subclinical" hypothyroidism (defined by high TSH, normal T4). That being
the case, the idea of Barnes that low body temperatures define
hypothyroidism even in face of normal TSH and T4s, is somewhat laughable. If
you can't see it in people whose pituitaries are struggling to keep up with
a damaged gland, you certainly aren't going to see it in people with
perfectly normal hormone levels.


Am J Med 2002 Apr 1;112(5):348-54

Comment in:
Am J Med. 2002 Apr 1;112(5):422-3.

A 6-month randomized trial of thyroxine treatment in women with mild
subclinical hypothyroidism.

Kong WM, Sheikh MH, Lumb PJ, Freedman DB, Crook M, Dore CJ, Finer N.

Department of Endocrinology, Faculty of Medicine, Imperial College School of
Science, Technology and Medicine, Commonwealth Building 6th Floor,
Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.

PURPOSE: The role of thyroxine replacement in subclinical hypothyroidism
remains unclear. We performed a 6-month randomized, double-blind,
placebo-controlled trial to evaluate the effects of thyroxine treatment for
mild subclinical hypothyroidism, defined as a serum thyroid-stimulating
hormone level between 5 to 10 microU/mL with a normal serum free thyroxine
level (0.8-16 ng/dL). SUBJECTS AND METHODS: We randomly assigned 40 women
with mild subclinical hypothyroidism who had presented to their family
practitioners to either thyroxine treatment (n = 23; 50 to 100 microg daily)
or placebo (n = 17). Health-related quality of life (Hospital Anxiety and
Depression scale, 30-item General Health Questionnaire), fasting lipid
profiles, body weight, and resting energy expenditure were measured at
baseline and 6 months. RESULTS: The most common presenting symptoms were
fatigue (n = 33 [83%]) and weight gain (n = 32 [80%]). At presentation, 20
women (50%) had elevated anxiety scores and 22 (56%) had elevated scores on
the General Health Questionnaire. Thirty-five women completed the study.
There were no significant differences in the changes from baseline to 6
months between women in the thyroxine group and the placebo group for any of
the metabolic, lipid, or anthropometric variables measured, expressed as the
mean change in the thyroxine group minus the mean change in the placebo
group: body mass index, -0.3 kg/m(2) (95% confidence interval [CI]: -0.9 to
0.4 kg/m(2)); resting energy expenditure, -0.2 kcal/kg/24 h (95% CI: -1.3 to
1.0 kcal/kg/24 h); and low-density lipoprotein cholesterol, -4 mg/dL (95%
CI: -23 to 15 mg/dL). There was a significant worsening in anxiety scores in
the thyroxine group (scores increased in 8 of 20 women and were unchanged in
2 of 20) compared with the placebo group (scores increased in 1 of 14 women
and were unchanged in 6 of 14; P = 0.03). CONCLUSIONS; We observed no
clinically relevant benefits from 6 months of thyroxine treatment in women
with mild subclinical hypothyroidism.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 11904108 [PubMed - indexed for MEDLINE]


J Clin Endocrinol Metab 2001 Oct;86(10):4860-6
TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical
symptoms in subclinical hypothyroidism: a double blind, placebo-controlled
trial (Basel Thyroid Study).

Meier C, Staub JJ, Roth CB, Guglielmetti M, Kunz M, Miserez AR, Drewe J,
Huber P, Herzog R, Muller B.

Division of Endocrinology, Department of Central Laboratories, University
Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.

This study evaluated the effect of physiological, TSH-guided, L-thyroxine
treatment on serum lipids and clinical symptoms in patients with subclinical
hypothyroidism. Sixty-six women with proven subclinical hypothyroidism (TSH,
11.7 +/- 0.8 mIU/liter) were randomly assigned to receive L-thyroxine or
placebo for 48 wk. Individual L-thyroxine replacement (mean dose, 85.5 +/-
4.3 microg/d) was performed based on blinded TSH monitoring, resulting in
euthyroid TSH levels (3.1 +/- 0.3 mIU/liter). Lipid concentrations and
clinical scores were measured before and after treatment. Sixty-three of 66
patients completed the study. In the L-thyroxine group (n = 31) total
cholesterol and low density lipoprotein cholesterol were significantly
reduced [-0.24 mmol/liter, 3.8% (P = 0.015) and -0.33 mmol/liter, 8.2% (P =
0.004), respectively]. Low density lipoprotein cholesterol decrease was more
pronounced in patients with TSH levels greater than 12 mIU/liter or elevated
low density lipoprotein cholesterol levels at baseline. A significant
decrease in apolipoprotein B-100 concentrations was observed (P = 0.037),
whereas high density lipoprotein cholesterol, triglycerides, apolipoprotein
AI, and lipoprotein(a) levels remained unchanged. Two clinical scores
assessing symptoms and signs of hypothyroidism (Billewicz and Zulewski
scores) improved significantly (P = 0.02). This is the first double blind
study to show that physiological L-thyroxine replacement in patients with
subclinical hypothyroidism has a beneficial effect on low density
lipoprotein cholesterol levels and clinical symptoms of hypothyroidism. An
important risk reduction of cardiovascular mortality of 9-31% can be
estimated from the observed improvement in low density lipoprotein

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 11600554 [PubMed - indexed for MEDLINE]

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