Anemia Management in Hashimoto's Thyroiditis

Introduction to Anemia of Chronic Disease

The European Medicines Agency states that ESAs are not indicated for patients not treated with chemotherapy, and their use may increase the risk of death, as recommended by the European Medicines Agency 1, 2, 3

The American Gastroenterological Association recommends IV iron for patients with inflammatory conditions where oral iron absorption is impaired, as stated by the American Gastroenterological Association 7
Intravenous iron produces significantly greater hemoglobin responses than oral iron in inflammatory conditions, with a response rate of 73% vs 41-45% with oral iron, according to the Journal of the National Comprehensive Cancer Network 5, 6
Ferritin <100 ng/mL with ongoing inflammation indicates absolute iron deficiency that requires correction before any other intervention, as indicated by the Annals of Oncology and the Journal of the National Comprehensive Cancer Network 4, 5, 6

Administer ferric carboxymaltose or iron isomaltoside as single high-dose infusions to rapidly replete iron stores, as recommended by the Annals of Oncology and Praxis Medical Insights 4, 7
Target ferritin >100 ng/mL and transferrin saturation >20% before considering any additional interventions, according to the Annals of Oncology and the Journal of the National Comprehensive Cancer Network 4, 5, 6

With IV iron repletion, hemoglobin should increase by ≥1 g/dL within 4 weeks, with corresponding improvement in fatigue and functional capacity, as stated by the Journal of the National Comprehensive Cancer Network 5, 6
Hemoglobin response rates of 73-87% are achievable with IV iron in inflammatory conditions, according to the Journal of the National Comprehensive Cancer Network 5, 6

ESAs increase thrombotic event risk, particularly dangerous in inflammatory conditions that already promote hypercoagulability, as indicated by the Annals of Oncology 4, 1
ESAs only work in 60% of patients and induce functional iron deficiency over time, worsening the underlying problem, according to the Annals of Oncology 4, 1
Without adequate iron stores, ESAs cannot stimulate effective erythropoiesis and will fail, as stated by the Annals of Oncology and the Journal of the National Comprehensive Cancer Network 4, 5, 6