Glycosylated Hemoglobin among Non-diabetic Patients Diagnosed as Benign Thyroid Lesions on Cytology: A Cross Sectional Study from a Tertiary Care Centre in India

Sujata Raychaudhuri, Reetika Menia, Mitasha Singh, Mukta Pujani, Nimisha Sharma, Teena Gupta, Harnam Kaur


Background: Hypothyroidism and diabetes usually coexist and are the most common endocrine disorders seen in India (1). Glycosylated Hb (HbA1c) is used for assessment of glycemia and American Diabetic Association (ADA) has recommended its use in diabetes and prediabetes (2). A value between 5.7% and 6.5% represents prediabetes while a value ≥6.5% is considered as diabetes mellitus (3). Glycosylated hemoglobin is a fraction of hemoglobin that undergoes non-enzymatic glycation over the circulatory life span of erythrocytes (4). Several studies have shown glycosylated Hb varies in different conditions like hemoglobinopathies, pregnancy and chronic kidney disease (5).

Thyroid hormone plays an important role in glucose homeostasis (6). TSH regulates hematopoiesis in bone marrow (7). Hypothyroidism depresses the marrow which causes decreased erythrocyte production which alters the life span of erythrocytes. Altered life span causes spurious elevation of HbA1C (8, 9, 10). Hence, glycosylated Hb not only depends on glycemia but also on life span of RBC (11). Conditions which effect erythrocyte turnover or survival lead to falsely high or low Hb A1C levels (12). RBC turnover is increased in thyrotoxic states whereas hypothyroidism has the opposite effect (3).

In the present study, we hypothesise that glycosylated hemoglobin shows variation in individuals with altered thyroid status. It also aim to establish if a correlation exits between fasting plasma glucose level and hemoglobin with glycosylated hemoglobin in patients with altered thyroid status.

Aims and Objectives: To find a correlation between thyroid profile and glycosylated Hb in non-diabetic patients who have been diagnosed on cytology as benign thyroid lesions and Compare the fasting blood glucose and hemoglobin with glycosylated Hb in these patients.

Material and Methods: A cross sectional study on 50 cases cytologically diagnosed as benign thyroid lesions in the Department of Pathology in ESIC Medical College and Hospital Faridabad were included in the study with consent of ethical committee.

Data Analysis: Pearson’s coefficient was applied to test the association between variables. The significance level was set at 5%.

Results: Out of 50 patients (n=25) 50% were hypothyroid, (n=13) 26% were hyperthyroid and (n=12) 24% were euthyroid and (n=22) 88% hypothyroid patients presented with HbA1C >6.5% and were labeled as Diabetic, (n=3) 12% hypothyroid patients were labelled as prediabetic and none was nondiabetic. Most of the euthyroid (n=11) 92% and all of the hyperthyroid patients (n=13) 100% had HbA1C in the nondiabetic range of <5.7%. Only one euthyroid patient (8%) had HbA1C in the prediabetic range. It was observed that microcytic hypochromic anemia was commoner in hypothyroid patients with HbA1C in diabetic range (HbA1C>6.5%). The correlation of HbA1C with TSH, Hb and MCH of these patients showed statistical significance (p <0.001). Relation of FBS with HbA1C was not significant.

Conclusion: The study suggests that physicians dealing with patients having altered thyroid status should interpret glycosylated hemoglobin with caution before labelling them as diabetic (HbAIc >6.5%) or prediabetic (HbAIc between 5.7 to 6.5%).


Anemia, Benign Thyroid, FBS, Glycosylated Hemoglobin

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Christy AL, Manjrekar P, Babu RP et al. Elevation of

HbA1C in non-diabetic hypothyroid individuals: is

anaemia the connecting link? - a preliminary study.

JCDR 2013; 7(11): 2442-44.

American Diabetes Association. Diagnosis and

Classification of Diabetes Mellitus. Diabetes Care 2010;

: S62-9.

Bhattacharjee R, Thukral A, Chakraborty PP et al.

Effects of thyroid status on glycated hemoglobin. Indian

Journal of Endocrinology and Metabolism 2017; 21(1):


Anantarapu S, Vaikkakara S, Sachan A et al. Effects

of thyroid hormone replacement on glycated

hemoglobin levels in non-diabetic subjects with overt

hypothyroidism. Arch Endocrinol Metab 2015; 59(6):


Nitin S, Mishra T, Tejinder S et al. Effect of iron deficiency

anaemia on haemoglobin A1c levels. Ann Lab Med

; 32: 17-22.

Yadav P, Kaushik GG, Sharma S. Importance of

screening type-II diabetics for thyroid dysfunction

and dyslipidemia. International Journal of Biochemistry

and Biophysics 2015; 3(2): 7-12.

Golde DW, Bersch N, Chopra IJ, et al. Thyroid hormones

stimulate erythropoiesis in vitro. The British Journal

of Haematology 1977; 37: 173-7.

Horton L, Coburn RJ, England JM et al. The hematology

of hypothyroidism. Q J Med 1975; 45(177): 101-23.

Das KC, Mukherjee M, Sarkar TK et al. Erythropoiesis

and erythropoietin in hypo and hyperthyroidism. J Clin

Endocrinol Metab 1975; 40: 211-20.

Fein HG, Rivlin RS. Anaemia in thyroid diseases. Med

Clin North Am 1975; 59: 1133-45.

Ram VS, Kumar G, Kumar M et al. Association of

subclinical hypothyroidism and HbA1c levels in nondiabetic

subjects attending rural tertiary care centre

in Central India. International Journal of Research in

Medical Sciences 2017; 5(8): 3345-9.

World Health Organization. Prevention and control of

Iron Deficiency Anemia in women and children: Report

of the UNICEF/WHO Regional Consultation February

World Health Organization, Geneva. 2001.

Mehmet E, Aybike K, Ganidagli S et al. Characteristics of

anemia in subclinical and overt hypothyroid patients.

Endocrine Journal 2012; 59(3): 213-20.

Iddah MA, Macharia BN, Ng’wena AG et al. Thyroid

hormones and hematological indices levels in thyroid

disorders patients at Moi Teaching and Referral

Hospital, Western Kenya. ISRN Endocrinology 2013; 1-6.

Kim MK, Kwon HS, Baek KH et al. Effects of thyroid

hormone on A1C and glycated albumin levels in

nondiabetic subjects with overt hypothyroidism.

Diabetes Care 2010; 33(12): 2546-8.

Dhadhal R, Chabra RJ, Mangukiya K et al. A Study

of Glycated Hemoglobin (HbA1c) in Non Diabetic

Hypothyroid Population. IJHSR 2015; 5(3): 127-132.

Vanderpump M. Thyroid autoimmunity following an

iodization programme. Clin Endocrinol (Oxf) 2011;

: 101.

Hardikar PS, Joshi SM, Bhat DS et al. Spuriously high

prevalence of prediabetes diagnosed by HbA(1c) in

young Indians partly explained by hematological factors

and iron deficiency anaemia. Diabetes Care 2012;

(4): 797-802.

Diez JJ, Iglesias P, Burman KD. Spontaneous

normalization of thyrotropin concentrations in patients

with subclinical hypothyroidism. J Clin Endocrinol

Metab 2005, 90: 4124-7.

Koga M, Morita S, Saito H et al. Association of

erythrocyte indices with glycated haemoglobin in

premenopausal women. Diabet Med 2007; 24: 843-7.

Coban E, Ozdogan M, Timuragaoglu A. Effect of iron

deficiency anaemia on the levels of haemoglobin A1c in

nondiabetic patients. Acta Haematol 2004; 112: 126-8.


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