head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2022, vol. 28, issue1
Subject Area: Medicine
DOI: 10.5272/jimab.2022281.4194
Published online: 20 January 2022

Original article
J of IMAB. 2022 Jan-Mar;28(1):4194-4201
Ginka Delcheva1ORCID logo Corresponding Autoremail, Ana Maneva1ORCID logo, Tanya Deneva2ORCID logo, Anelia Bivolarska1ORCID logo,
1) Department of Medical Biochemistry, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria.
2) Department of Clinical Laboratory, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria.

Purpose: Pregnancy is often complicated by iron deficiency, affecting negatively thyroid gland physiology. The aim of our study is to investigate parameters of iron and thyroid status during І, ІІ and ІІІ trimester of pregnancy in order to establish potential correlations in their dynamics. 
Materials and methods: The study involved 61 pregnant women and 43 controls. Their iron and thyroid status was determined by measuring hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (sTfR), thyroxine (FT4) and thyroid-stimulating hormone (TSH).
Results: Significant differences between pregnant women and the control group were found, indicating an iron deficiency risk: sTfR level was higher, while Hb, ferritin and FT4 levels were lower in pregnant women. Thyroxine correlated positively with Hb (p = 0.016) and ferritin (p = 0.003) in pregnant women. In the I trimester, there was a negative association between sTfR and FT4 (p = 0.013), and in the III trimester, there was a positive association between sTfR and TSH (p < 0.0001).
Conclusions: sTfR represented the relationship between iron and thyroid status in the I and III trimester. Iron deficiency was expressed in the III trimester with a positive association between sTfR and TSH. The increased maternal iron requirement (sTfR) correlated with increased TSH secretion induced by decreased thyroxine.

Keywords: iron deficiency, pregnant women, ferritin, sTfR, thyroxine, TSH,

pdf - Download FULL TEXT /PDF 1297 KB/
Please cite this article as: Delcheva G, Maneva A, Deneva T, Bivolarska A. Association between iron and thyroid status in pregnant women. J of IMAB. 2022 Jan-Mar;28(1):4194-4201. DOI: 10.5272/jimab.2022281.4194

Corresponding AutorCorrespondence to: Ginka Delcheva, Department of Medical Biochemistry, Faculty of Pharmacy, Medical University of Plovdiv; 15A, Vasil Aprilov Blvd., 4002 Plovdiv, Bulgaria; E-mail: ginka.delcheva@mu-plovdiv.bg

1. Hernik A, Szczepanek-Parulska E, Filipowicz D, Czarnywojtek A, Wrotkowska E, Kramer L, et al. Hepcidin and Iron Homeostasis in Patients with Subacute Thyroiditis and Healthy Subjects. Mediat Inflamm. 2019 Feb;2019:5764061. [PubMed]
2. Khatiwada S, Gelal B, Baral N, Lamsal M. Association between iron status and thyroid function in Nepalese children. Thyroid Res. 2016 Jan;9:2. [PubMed]
3. Bastian TW, Anderson JA, Fretham SJ, Prohaska JR, Georgieff MK, Anderson GW. Fetal and neonatal iron deficiency reduces thyroid hormone-responsive gene mRNA levels in the neonatal rat hippocampus and cerebral cortex. Endocrinology. 2012 Nov;153(11):5668-80. [PubMed]
4. Zhou M, Liao QK, Li FY, Li Q, Luo CH, Gao J, et al. [Effect of T3 on the expression of transferrin receptor and ferritin in K562 cells and its possible mechanism.] [In Chinese] Zhonghua Xue Ye Xue Za Zhi.  2003 Apr;24(4):181-4. [PubMed]
5. Takamatsu J, Majima M, Miki K, Kuma K, Mozai T. Serum ferritin as a marker of thyroid hormone action on peripheral tissues. J Clin Endocrinol Metab. 1985 Oct;61(4):672-6. [PubMed]
6. Lin KH, Lee CH, Yen CC, Chen SI, Yang RC, Wang CS. Plasma protein regulation by thyroid hormone. J Endocrinol. 2003 Dec;179(3):367-77. [PubMed]
7. Fu J, Yang A, Zhao J, Zhu Y, Gu Y, Xu Y, et al. The relationship between iron level and thyroid function during the first trimester of pregnancy: A cross-sectional study in Wuxi, China. J Trace Elem Med Biol. 2017 Sept;43:148-52. [PubMed]
8. Zimmermann MB, Köhrle J. The impact of iron and selenium deficiencies on iodine and thyroid metabolism: biochemistry and relevance to public health. Thyroid. 2002 Oct;12(10):867-78. [PubMed]
9. 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 Mar;142(3):217-23. [PubMed]
10. Zimmermann MB, Zeder C, Chaouki N, Torresani T, Saad A, Hurrell RF. Addition of microencapsulated iron to iodized salt improves the efficacy of iodine in goitrous, iron-deficient children: a randomized, double-blind, controlled trial. Eur J Endocrinol. 2002 Dec;147(6):747-53. [PubMed]
11. Zimmermann MB. The influence of iron status on iodine utilization and thyroid function. Annu Rev Nutr. 2006; 26:367-89. [PubMed]
12. Zimmermann MB, Wegmueller R, Zeder C, Chaouki N, Rohner F, Saïssi M, et al. Dual fortification of salt with iodine and micronized ferric pyrophosphate: a randomized, double-blind, controlled trial. Am J Clin Nutr. 2004 Oct;80(4):952-9. [PubMed]
13. Shakir KM, Chute JP, Aprill BS, Lazarus AA. Ferrous sulfate-induced increase in requirement for thyroxine in a patient with primary hypothyroidism. South Med J. 1997 Jun;90(6):637-9. [PubMed]
14. Ravanbod M, Asadipooya K, Kalantarhormozi M, Nabipour I, Omrani GR. Treatment of iron-deficiency anemia in patients with subclinical hypothyroidism. Am J Med. 2013 May;126(5):420-4. [PubMed]
15. Banday TH, Bhat SB, Bhat SB, Bashir S, Naveed S. Incipient iron deficiency in primary hypothyroidism. Thyroid Res Pract. 2018 Nov;15(3):138-41. [Crossref]
16. Zhang Y, Huang X, Chen Z, Yang Q, Li X, Zhang R, et al. Iron deficiency, a risk factor for thyroid autoimmunity during second trimester of pregnancy in China. Endocr Pract. 2020 Jun;26(6):595-603. [PubMed]
17. Zimmermann MB, Burgi H, Hurrell RF. Iron deficiency predicts poor maternal thyroid status during pregnancy. J Clin Endocrinol Metab. 2007 Sept;92(9):3436-40. [PubMed]
18. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. World Health Organization. 2011. [Internet]
19. Gatseva PD, Bivolarska AV, Argirova MD. Results from the national strategy for improvement in iodine nutrition in Bulgaria. A study of children and pregnant women living in an iodine-deficient area. J Publ Health. 2011 Apr;19(3):237-40. [Crossref]
20. Bivolarska A, Gatseva P, Maneva A, Deneva T, Porjasov D, Delcheva G. Association between nutritional behaviour and the risk of iron deficiency among pregnant women. Trakia J Sci. 2012;10(1):104-9.
21. Iqbal S, Rust P, Weitensfelder L, Ali I, Kundi M, Moshammer H, et al. Iron and Iodine Status in Pregnant Women from A Developing Country and Its Relation to Pregnancy Outcomes. Int J Environ Res Public Health. 2019 Nov;16(22):4414. [PubMed]
22. Okafor IM, Antai AB, Usanga EA. Evaluation of soluble transferrin receptor, soluble transferrin receptor/ferritin ratio, and other iron-related parameters of pregnant women in Cross River State, Nigeria. Trop J Med Res. 2017 Jul-Dec;20(2):180-84.
23. Gur EB, Karadeniz M, Inceefe H, Tatar S, Turan GA, Genc M, et al. Thyroid antibodies in euthyroid and subclinical hypothyroidic pregnant women with autoimmune hypothyroidism: effects on hematological parameters and postpartum hemorrhage. Pol Gynaecol. 2015 Apr;86(9):666-71. [PubMed]
24. Tong F, Chen L, Zhao Z. Elevated serum ferritin and soluble transferrin receptor in infants with congenital hypothyroidism. J Pediatr Endocrinol Metab. 2012; 25(3-4):249-53. [PubMed].

Received: 07 June 2021
Published online: 20 January 2022

back to Online Journal