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The Relationship Between Hypothyroidism-Induced Autoantibodies, TSH Levels, and RDW, as an Inflammation Marker

Year 2023, , 56 - 66, 30.04.2023
https://doi.org/10.36516/jocass.1210920

Abstract

Aim: Serum RDW grades were detected in patients with Hashimoto's thyroiditis. We aimed to use RDW to detect increased cardiovascular events in patients, increased oxidative stress, and inflammation without the need for an additional cost.
Methods: We collected 904 persons results, 462 patients which have Hashimoto's thyroiditis, and 442 age and sex-matched control cases were comprised in our study. From laboratory measurements of the patients’ records were utilized such as hemogram, hs-CRP, fasting blood glucose, insulin, C-peptide, kidney function tests, liver function tests (ALT, AST), serum lipids (total cholesterol, triglyceride, HDL, LDL), anti-Tg, and anti-TPO, FT3, FT4, TSH levels.
Results: RDW was considerably scaled up in case group compared to control group (Hashimoto's thyroiditis =10.08 ± 4.48%, control = 8.95 ± 6.68%, p <0.05). Also, MPV was increased in the study group(p<0.05). hs-CRP showed a statistically significant positive correlation between the level of RDW.
Conclusion: Although the exact mechanism is still not fully understood, increased RDW levels in individuals with Hashimoto’s thyroiditis, possibly related to ongoing subclinical inflammation, neurohumoral activation, and changes resulting from oxidative stress in such patients.
RDW is potentially a valuable tool for assessing cardiovascular diseases among patients diagnosed with Hashimoto's thyroiditis.

Supporting Institution

yok

Project Number

yok

References

  • 1. Ciccone MM, De Pergola G, Porcelli MT, et al. Increased carotid IMT in overweight and obese women affected by Hashimoto’s thyroiditis: An adiposity and autoimmune linkage? BMC Cardiovasc Disord. 2010;10. doi:10.1186/1471-2261-10-22
  • 2. Hollowell JG, Staehling NW, Dana Flanders W, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). Journal of Clinical Endocrinology and Metabolism. 2002;87(2):489-499. doi:10.1210/jcem.87.2.8182
  • 3. Steel NR, Weightman DR, Taylor JJ, Kendall-Taylor P. Blocking activity to action of thyroid stimulating hormone in serum from patients with primary hypothyroidism. Br Med J. 1984;288(6430):1559-1562. doi:10.1136/bmj.288.6430.1559
  • 4. Chistiakov DA. Immunogenetics of Hashimoto’s thyroiditis. J Autoimmune Dis. 2005;2:1-21. doi:10.1186/1740-2557-2-1
  • 5. Devendra D, Eisenbarth GS. 17. Immunologic endocrine disorders. Journal of Allergy and Clinical Immunology. 2003;111(2 SUPPL. 2):624-636. doi:10.1067/mai.2003.81
  • 6. Rodanaki M, Lodefalk M, Forssell K, Arvidsson CG, Forssberg M, Åman J. The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden. Horm Res Paediatr. 2019;91(3):195-202. doi:10.1159/000500265
  • 7. Tam AA, Kaya C, Üçler R, Dirikoç A, Ersoy R, Çakır B. Correlation of normal thyroid ultrasonography with thyroid tests. Quant Imaging Med Surg. 2015;5(4):569-56974. doi:10.3978/j.issn.2223-4292.2015.08.06
  • 8. Nakamura M, Imamura T, Sobajima M, Kinugawa K. Initial experience of hypoxia inducible factor prolyl hydroxylase inhibitors in patients with heart failure and renal anemia. Heart Vessels. 2022;(0123456789). doi:10.1007/s00380-022-02181-1
  • 9. Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2008;117(2):163-168. doi:10.1161/CIRCULATIONAHA.107.727545
  • 10. Pascual-Figal DA, Bonaque JC, Redondo B, et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail. 2009;11(9):840-846. doi:10.1093/eurjhf/hfp109
  • 11. Escobar-Morreale HF, Luque-Ramírez M, González F. Circulating inflammatory markers in polycystic ovary syndrome: A systematic review and metaanalysis. Fertil Steril. 2011;95(3):1-23. doi:10.1016/j.fertnstert.2010.11.036
  • 12. Buckley DI, Fu R, Freeman M, Rogers K, Helfand M. C-reactive protein as a risk factor for coronary heart disease: A systematic review and meta-analyses for the U.S. preventive services task force. Ann Intern Med. 2009;151(7):483-495. doi:10.7326/0003-4819-151-7-200910060-00009
  • 13. Veeranna V, Zalawadiya SK, Panaich S, Patel K V., Afonso L. Comparative analysis of red cell distribution width and high sensitivity C-reactive protein for coronary heart disease mortality prediction in multi-ethnic population: Findings from the 1999-2004 NHANES. Int J Cardiol. 2013;168(6):5156-5161. doi:10.1016/j.ijcard.2013.07.109
  • 14. Afonso L, Zalawadiya SK, Veeranna V, Panaich SS, Niraj A, Jacob S. Relationship between red cell distribution width and microalbuminuria: A population-based study of multiethnic representative US adults. Nephron Clin Pract. 2011;119(4):277-282. doi:10.1159/000328918
  • 15. Wiersinga WM. The role of thyroid hormone nuclear receptors in the heart: Evidence from pharmacological approaches. Heart Fail Rev. 2010;15(2):121-124. doi:10.1007/s10741-008-9131-9
  • 16. Chanprapaph K, Iamsumang W, Wattanakrai P, Vachiramon V. Thyroid autoimmunity and autoimmunity in chronic spontaneous urticaria linked to disease severity, therapeutic response, and time to remission in patients with chronic spontaneous urticaria. Biomed Res Int. 2018;2018. doi:10.1155/2018/9856843
  • 17. Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med. 2012;50(4):635-641. doi:10.1515/cclm.2011.831
  • 18. Marinkovic D, Zhang X, Yalcin S, et al. Foxo3 is required for the regulation of oxidative stress in erythropoiesis. Journal of Clinical Investigation. 2007;117(8):2133-2144. doi:10.1172/JCI31807
  • 19. Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart J. 2009;50(3):301-312. doi:10.1536/ihj.50.301
  • 20. Hak AE, Pols HAP, Visser TJ, Drexhage HA, Hofman A, Witteman JCM. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam study. Ann Intern Med. 2000;132(4):270-278. doi:10.7326/0003-4819-132-4-200002150-00004
  • 21. Duman D, Sahin S, Esertas K, Demirtunc R. Simvastatin improves endothelial function in patents with subclinical hypothyroidism. Heart Vessels. 2007;22(2):88-93. doi:10.1007/s00380-006-0950-0
  • 22. Aktas G, Sit M, Dikbas O, et al. Could red cell distribution width be a marker in Hashimoto’s Thyroiditis? Experimental and Clinical Endocrinology and Diabetes. 2014;122(10):572-574. doi:10.1055/s-0034-1383564
  • 23. Chang X, Zhang S, Zhang M, et al. Free triiodothyronine and global registry of acute coronary events risk score on predicting long-term major adverse cardiac events in STEMI patients undergoing primary PCI. Lipids Health Dis. 2018;17(1):13971-13980. doi:10.1186/s12944-018-0881-7
  • 24. Bremner AP, Feddema P, Joske DJ, et al. Significant association between thyroid hormones and erythrocyte indices in euthyroid subjects. Clin Endocrinol (Oxf). 2012;76(2):304-311. doi:10.1111/j.1365-2265.2011.04228.x
  • 25. Montagnana M, Lippi G, Targher G, Salvagno GL, Guidi GC. LE 581-582 Letter to the editor. Int J Lab Hematol. 2009;31(5):581-582. doi:10.1111/j.1751-553X.2008.01082.x
  • 26. Arhan M, Önal IK, Taş A, et al. The role of red cell distribution width as a marker in inflammatory bowel disease. Turk J Med Sci. 2011;41(2):227-234. doi:10.3906/sag-0912-418
  • 27. Yudkin JS, Stehouwer CDA, Emeis JJ, Coppack SW. Obesity , Insulin Resistance , and Endothelial Dysfunction. Arterioscler Thromb Vasc Biol. 1999;19(4):972-978.
  • 28. Carlioglu A, Timur O, Durmaz SA, Ayhan ME. Mean platelet volume in euthyroid patients with Hashimoto’s thyroiditis. Blood Coagulation and Fibrinolysis. 2015;26(3):282-284. doi:10.1097/MBC.0000000000000236
  • 29. Jabeen F, Fawwad A, Rizvi HA, Alvi F. Role of platelet indices, glycemic control and hs-crp in pathogenesis of vascular complications in type-2 diabetic patients. Pak J Med Sci. 2013;29(1):152-156. doi:10.12669/pjms.291.2592
  • 30. Brown AS, Hong Y, De Belder A, et al. Megakaryocyte ploidy and platelet changes in human diabetes and atherosclerosis. Arterioscler Thromb Vasc Biol. 1997;17(4):802-807. doi:10.1161/01.ATV.17.4.802
  • 31. Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008;75(3):291-294. doi:10.1016/j.jbspin.2007.06.016
  • 32. McDermott MT, Ridgway EC. Subclinical hypothyroidism is mild thyroid failure and should be treated. Journal of Clinical Endocrinology and Metabolism. 2001;86(10):4585-4590. doi:10.1210/jcem.86.10.7959
  • 33. Perlstein TS, Weuve J, Pfeffer M, Beckman J. Red blood cell distribution width and mortality risk in a community-based prospective cohort: NHANES III: RDW and mortality risk. Arch Intern Med. 2012;169(6):588-594. doi:10.1001/archinternmed.2009.55.Red
  • 34. Karkoutly S, Hammoud T, Al-Quobaili F. Effect of hypothyroidism on haematological parameters: A gender- based comparison. New Zealand Journal of Medical Laboratory Science. 2020;74(2):98-102.
  • 35. Ahmed SS, Mohammed AA. Effects of thyroid dysfunction on hematological parameters: Case controlled study. Annals of Medicine and Surgery. 2020;57(May):52-55. doi:10.1016/j.amsu.2020.07.008
  • 36. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):1-12. doi:10.1001/jamanetworkopen.2020.3976
  • 37. Mwafy SN, Yassin MM, Mousa RM. Thyroid function, metabolic parameters and anthropometric changes among Palestinian obese adult females. Obes Med. 2020;17(October 2019):100159. doi:10.1016/j.obmed.2019.100159
  • 38. Wang P, Huang C, Meng Z, et al. No obvious association exists between red blood cell distribution width and thyroid function. Biomark Med. 2019;13(16):1363-1372. doi:10.2217/bmm-2018-0476
  • 39. Ortíz Pérez M, Vázquez López MA, Ibáñez Alcalde M, et al. Relationship between Obesity and Iron Deficiency in Healthy Adolescents. Childhood Obesity. 2020;16(6):440-447. doi:10.1089/chi.2019.0276
  • 40. Liang J, Nong S, Jiang L, et al. Correlations of disease severity and age with hematology parameter variations in patients with COVID-19 pre- and post-treatment. J Clin Lab Anal. 2021;35(1):1-7. doi:10.1002/jcla.23609

The Relationship Between Hypothyroidism-Induced Autoantibodies, TSH Levels, and RDW, as an Inflammation Marker

Year 2023, , 56 - 66, 30.04.2023
https://doi.org/10.36516/jocass.1210920

Abstract

Aim: Serum RDW grades were detected in patients with Hashimoto's thyroiditis. We aimed to use RDW to detect increased cardiovascular events in patients, increased oxidative stress, and inflammation without the need for an additional cost.
Methods: We collected 904 persons results, 462 patients which have Hashimoto's thyroiditis, and 442 age and sex-matched control cases were comprised in our study. From laboratory measurements of the patients’ records were utilized such as hemogram, hs-CRP, fasting blood glucose, insulin, C-peptide, kidney function tests, liver function tests (ALT, AST), serum lipids (total cholesterol, triglyceride, HDL, LDL), anti-Tg, and anti-TPO, FT3, FT4, TSH levels.
Results: RDW was considerably scaled up in case group compared to control group (Hashimoto's thyroiditis =10.08 ± 4.48%, control = 8.95 ± 6.68%, p <0.05). Also, MPV was increased in the study group(p<0.05). hs-CRP showed a statistically significant positive correlation between the level of RDW.
Conclusion: Although the exact mechanism is still not fully understood, increased RDW levels in individuals with Hashimoto’s thyroiditis, possibly related to ongoing subclinical inflammation, neurohumoral activation, and changes resulting from oxidative stress in such patients.
RDW is potentially a valuable tool for assessing cardiovascular diseases among patients diagnosed with Hashimoto's thyroiditis.

Project Number

yok

References

  • 1. Ciccone MM, De Pergola G, Porcelli MT, et al. Increased carotid IMT in overweight and obese women affected by Hashimoto’s thyroiditis: An adiposity and autoimmune linkage? BMC Cardiovasc Disord. 2010;10. doi:10.1186/1471-2261-10-22
  • 2. Hollowell JG, Staehling NW, Dana Flanders W, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). Journal of Clinical Endocrinology and Metabolism. 2002;87(2):489-499. doi:10.1210/jcem.87.2.8182
  • 3. Steel NR, Weightman DR, Taylor JJ, Kendall-Taylor P. Blocking activity to action of thyroid stimulating hormone in serum from patients with primary hypothyroidism. Br Med J. 1984;288(6430):1559-1562. doi:10.1136/bmj.288.6430.1559
  • 4. Chistiakov DA. Immunogenetics of Hashimoto’s thyroiditis. J Autoimmune Dis. 2005;2:1-21. doi:10.1186/1740-2557-2-1
  • 5. Devendra D, Eisenbarth GS. 17. Immunologic endocrine disorders. Journal of Allergy and Clinical Immunology. 2003;111(2 SUPPL. 2):624-636. doi:10.1067/mai.2003.81
  • 6. Rodanaki M, Lodefalk M, Forssell K, Arvidsson CG, Forssberg M, Åman J. The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden. Horm Res Paediatr. 2019;91(3):195-202. doi:10.1159/000500265
  • 7. Tam AA, Kaya C, Üçler R, Dirikoç A, Ersoy R, Çakır B. Correlation of normal thyroid ultrasonography with thyroid tests. Quant Imaging Med Surg. 2015;5(4):569-56974. doi:10.3978/j.issn.2223-4292.2015.08.06
  • 8. Nakamura M, Imamura T, Sobajima M, Kinugawa K. Initial experience of hypoxia inducible factor prolyl hydroxylase inhibitors in patients with heart failure and renal anemia. Heart Vessels. 2022;(0123456789). doi:10.1007/s00380-022-02181-1
  • 9. Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2008;117(2):163-168. doi:10.1161/CIRCULATIONAHA.107.727545
  • 10. Pascual-Figal DA, Bonaque JC, Redondo B, et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail. 2009;11(9):840-846. doi:10.1093/eurjhf/hfp109
  • 11. Escobar-Morreale HF, Luque-Ramírez M, González F. Circulating inflammatory markers in polycystic ovary syndrome: A systematic review and metaanalysis. Fertil Steril. 2011;95(3):1-23. doi:10.1016/j.fertnstert.2010.11.036
  • 12. Buckley DI, Fu R, Freeman M, Rogers K, Helfand M. C-reactive protein as a risk factor for coronary heart disease: A systematic review and meta-analyses for the U.S. preventive services task force. Ann Intern Med. 2009;151(7):483-495. doi:10.7326/0003-4819-151-7-200910060-00009
  • 13. Veeranna V, Zalawadiya SK, Panaich S, Patel K V., Afonso L. Comparative analysis of red cell distribution width and high sensitivity C-reactive protein for coronary heart disease mortality prediction in multi-ethnic population: Findings from the 1999-2004 NHANES. Int J Cardiol. 2013;168(6):5156-5161. doi:10.1016/j.ijcard.2013.07.109
  • 14. Afonso L, Zalawadiya SK, Veeranna V, Panaich SS, Niraj A, Jacob S. Relationship between red cell distribution width and microalbuminuria: A population-based study of multiethnic representative US adults. Nephron Clin Pract. 2011;119(4):277-282. doi:10.1159/000328918
  • 15. Wiersinga WM. The role of thyroid hormone nuclear receptors in the heart: Evidence from pharmacological approaches. Heart Fail Rev. 2010;15(2):121-124. doi:10.1007/s10741-008-9131-9
  • 16. Chanprapaph K, Iamsumang W, Wattanakrai P, Vachiramon V. Thyroid autoimmunity and autoimmunity in chronic spontaneous urticaria linked to disease severity, therapeutic response, and time to remission in patients with chronic spontaneous urticaria. Biomed Res Int. 2018;2018. doi:10.1155/2018/9856843
  • 17. Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med. 2012;50(4):635-641. doi:10.1515/cclm.2011.831
  • 18. Marinkovic D, Zhang X, Yalcin S, et al. Foxo3 is required for the regulation of oxidative stress in erythropoiesis. Journal of Clinical Investigation. 2007;117(8):2133-2144. doi:10.1172/JCI31807
  • 19. Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart J. 2009;50(3):301-312. doi:10.1536/ihj.50.301
  • 20. Hak AE, Pols HAP, Visser TJ, Drexhage HA, Hofman A, Witteman JCM. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam study. Ann Intern Med. 2000;132(4):270-278. doi:10.7326/0003-4819-132-4-200002150-00004
  • 21. Duman D, Sahin S, Esertas K, Demirtunc R. Simvastatin improves endothelial function in patents with subclinical hypothyroidism. Heart Vessels. 2007;22(2):88-93. doi:10.1007/s00380-006-0950-0
  • 22. Aktas G, Sit M, Dikbas O, et al. Could red cell distribution width be a marker in Hashimoto’s Thyroiditis? Experimental and Clinical Endocrinology and Diabetes. 2014;122(10):572-574. doi:10.1055/s-0034-1383564
  • 23. Chang X, Zhang S, Zhang M, et al. Free triiodothyronine and global registry of acute coronary events risk score on predicting long-term major adverse cardiac events in STEMI patients undergoing primary PCI. Lipids Health Dis. 2018;17(1):13971-13980. doi:10.1186/s12944-018-0881-7
  • 24. Bremner AP, Feddema P, Joske DJ, et al. Significant association between thyroid hormones and erythrocyte indices in euthyroid subjects. Clin Endocrinol (Oxf). 2012;76(2):304-311. doi:10.1111/j.1365-2265.2011.04228.x
  • 25. Montagnana M, Lippi G, Targher G, Salvagno GL, Guidi GC. LE 581-582 Letter to the editor. Int J Lab Hematol. 2009;31(5):581-582. doi:10.1111/j.1751-553X.2008.01082.x
  • 26. Arhan M, Önal IK, Taş A, et al. The role of red cell distribution width as a marker in inflammatory bowel disease. Turk J Med Sci. 2011;41(2):227-234. doi:10.3906/sag-0912-418
  • 27. Yudkin JS, Stehouwer CDA, Emeis JJ, Coppack SW. Obesity , Insulin Resistance , and Endothelial Dysfunction. Arterioscler Thromb Vasc Biol. 1999;19(4):972-978.
  • 28. Carlioglu A, Timur O, Durmaz SA, Ayhan ME. Mean platelet volume in euthyroid patients with Hashimoto’s thyroiditis. Blood Coagulation and Fibrinolysis. 2015;26(3):282-284. doi:10.1097/MBC.0000000000000236
  • 29. Jabeen F, Fawwad A, Rizvi HA, Alvi F. Role of platelet indices, glycemic control and hs-crp in pathogenesis of vascular complications in type-2 diabetic patients. Pak J Med Sci. 2013;29(1):152-156. doi:10.12669/pjms.291.2592
  • 30. Brown AS, Hong Y, De Belder A, et al. Megakaryocyte ploidy and platelet changes in human diabetes and atherosclerosis. Arterioscler Thromb Vasc Biol. 1997;17(4):802-807. doi:10.1161/01.ATV.17.4.802
  • 31. Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008;75(3):291-294. doi:10.1016/j.jbspin.2007.06.016
  • 32. McDermott MT, Ridgway EC. Subclinical hypothyroidism is mild thyroid failure and should be treated. Journal of Clinical Endocrinology and Metabolism. 2001;86(10):4585-4590. doi:10.1210/jcem.86.10.7959
  • 33. Perlstein TS, Weuve J, Pfeffer M, Beckman J. Red blood cell distribution width and mortality risk in a community-based prospective cohort: NHANES III: RDW and mortality risk. Arch Intern Med. 2012;169(6):588-594. doi:10.1001/archinternmed.2009.55.Red
  • 34. Karkoutly S, Hammoud T, Al-Quobaili F. Effect of hypothyroidism on haematological parameters: A gender- based comparison. New Zealand Journal of Medical Laboratory Science. 2020;74(2):98-102.
  • 35. Ahmed SS, Mohammed AA. Effects of thyroid dysfunction on hematological parameters: Case controlled study. Annals of Medicine and Surgery. 2020;57(May):52-55. doi:10.1016/j.amsu.2020.07.008
  • 36. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):1-12. doi:10.1001/jamanetworkopen.2020.3976
  • 37. Mwafy SN, Yassin MM, Mousa RM. Thyroid function, metabolic parameters and anthropometric changes among Palestinian obese adult females. Obes Med. 2020;17(October 2019):100159. doi:10.1016/j.obmed.2019.100159
  • 38. Wang P, Huang C, Meng Z, et al. No obvious association exists between red blood cell distribution width and thyroid function. Biomark Med. 2019;13(16):1363-1372. doi:10.2217/bmm-2018-0476
  • 39. Ortíz Pérez M, Vázquez López MA, Ibáñez Alcalde M, et al. Relationship between Obesity and Iron Deficiency in Healthy Adolescents. Childhood Obesity. 2020;16(6):440-447. doi:10.1089/chi.2019.0276
  • 40. Liang J, Nong S, Jiang L, et al. Correlations of disease severity and age with hematology parameter variations in patients with COVID-19 pre- and post-treatment. J Clin Lab Anal. 2021;35(1):1-7. doi:10.1002/jcla.23609
There are 40 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Articles
Authors

Kemal Aygün This is me 0000-0002-2345-8909

Ozden Gokdemır 0000-0002-0542-5767

Ali Rıza Şişman 0000-0002-9266-0844

Tevfik Demir 0000-0003-0319-9572

Project Number yok
Publication Date April 30, 2023
Acceptance Date January 12, 2023
Published in Issue Year 2023

Cite

APA Aygün, K., Gokdemır, O., Şişman, A. R., Demir, T. (2023). The Relationship Between Hypothyroidism-Induced Autoantibodies, TSH Levels, and RDW, as an Inflammation Marker. Journal of Cukurova Anesthesia and Surgical Sciences, 6(1), 56-66. https://doi.org/10.36516/jocass.1210920
https://dergipark.org.tr/tr/download/journal-file/11303