{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:42:55Z","timestamp":1784853775480,"version":"3.55.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T00:00:00Z","timestamp":1642464000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Red blood cell distribution width (RDW) is an important parameter with broad biological implications. However, the study investigating the association between RDW and thyroid function remains sparse and inconsistent. We aimed to investigate the association between RDW and thyroid function in the US population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional analysis was performed using the data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2010. The thyroid parameters investigated were mainly free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), antithyroglobulin antibody (TgAb), and antithyroperoxidase antibody (TPOAb). In the 6,895 adults aged 18 years or older, logistic regression modeling was applied to estimate the association between RDW quartiles and thyroid parameters. Smooth curve fittings and generalized additive models were then performed to address the nonlinear relationship.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The association between RDW and TSH followed a J-shaped curve, and a significant positive relationship existed in the 12.5%\u201317.5% range of RDW (<jats:italic>\u03b2<\/jats:italic> \u2009= 0.350, 95% confidence interval (CI): 0.225 to 0.474), which was prominent in females. We further demonstrated a negative association (<jats:italic>\u03b2<\/jats:italic> = \u22120.018, 95% CI: \u22120.030 to \u22120.005) between RDW and fT3. Moreover, elevated RDW was more likely to be subclinical hypothyroidism. However, there was no obvious association between RDW and fT4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study confirmed a significant association between RDW and TSH, and future studies are needed to elucidate the underlying mechanisms of the peculiar RDW-fT3 relationship. RDW may be a significant clinical marker of subclinical hypothyroidism.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2021.807482","type":"journal-article","created":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T12:30:54Z","timestamp":1642509054000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Association Between Red Blood Cell Distribution Width and Thyroid Function"],"prefix":"10.3389","volume":"12","author":[{"given":"Guowei","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueqin","family":"Ai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaoyuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoqun","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"86","DOI":"10.3109\/10408363.2014.992064","article-title":"Red Blood Cell Distribution Width: A Simple Parameter With Multiple Clinical Applications","volume":"52","author":"Salvagno","year":"2015","journal-title":"Crit Rev Clin Lab Sci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-011-2331-1","article-title":"Association Between Red Blood Cell Distribution Width and Macrovascular and Microvascular Complications in Diabetes","volume":"55","author":"Malandrino","year":"2012","journal-title":"Diabetologia"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.20452\/pamw.3985","article-title":"Anemia in Thyroid Diseases","volume":"127","author":"Szczepanek-Parulska","year":"2017","journal-title":"Pol Arch Intern Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2014-0585","article-title":"Red Blood Cell Distribution Width (RDW) and Human Pathology. One Size Fits All","volume":"52","author":"Lippi","year":"2014","journal-title":"Clin Chem Lab Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.02.067","article-title":"Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure: Data From the CHARM Program and the Duke Databank","volume":"50","author":"Felker","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.01.045","article-title":"Red Cell Distribution Width and Risk of Cardiovascular Mortality: Insights From National Health and Nutrition Examination Survey (NHANES)-III","volume":"232","author":"Shah","year":"2017","journal-title":"Int J Cardiol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.727545","article-title":"Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease","volume":"117","author":"Tonelli","year":"2008","journal-title":"Circulation"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2012.758697","article-title":"Red Blood Cell Distribution and Survival in Patients With Chronic Obstructive Pulmonary Disease","volume":"10","author":"Seyhan","year":"2013","journal-title":"COPD"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.55","article-title":"Red Blood Cell Distribution Width and Mortality Risk in a Community-Based Prospective Cohort","volume":"169","author":"Perlstein","year":"2009","journal-title":"Arch Intern Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.7150\/jca.31598","article-title":"Prognostic Role of Pretreatment Red Blood Cell Distribution Width in Patients With Cancer: A Meta-Analysis of 49 Studies","volume":"10","author":"Wang","year":"2019","journal-title":"J Cancer"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2019.101373","article-title":"Thyro-Entero-Gastric Autoimmunity: Pathophysiology and Implications for Patient Management","volume":"34","author":"Lahner","year":"2020","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e2022058","DOI":"10.1001\/jamanetworkopen.2020.22058","article-title":"Association of Red Blood Cell Distribution Width With Mortality Risk in Hospitalized Adults With SARS-CoV-2 Infection","volume":"3","author":"Foy","year":"2020","journal-title":"JAMA Netw Open"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-05-783043","article-title":"Thyroid Hormone Regulates Hematopoiesis via the TR-KLF9 Axis","volume":"130","author":"Zhang","year":"2017","journal-title":"Blood"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2007.03091.x","article-title":"Chronic Unexplained Anaemia in Isolated Autoimmune Thyroid Disease or Associated With Autoimmune Related Disorders","volume":"68","author":"Sibilla","year":"2008","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1977.tb06833.x","article-title":"Thyroid Hormones Stimulate Erythropoiesis In Vitro","volume":"37","author":"Golde","year":"1977","journal-title":"Br J Haematol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-00888","article-title":"Low-Normal Thyroid Function Predicts Incident Anemia in the General Population With Euthyroid Status","volume":"104","author":"Gu","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V45.5.671.671","article-title":"Direct Effects of Thyroid Hormones on Bone Marrow Erythroid Cells of Rats","volume":"45","author":"Malgor","year":"1975","journal-title":"Blood"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1383564","article-title":"Could Red Cell Distribution Width be a Marker in Hashimoto\u2019s Thyroiditis","volume":"122","author":"Aktas","year":"2014","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1590\/0004-2730000002836","article-title":"The Value of Red Blood Cell Distribution Width in Subclinical Hypothyroidism","volume":"58","author":"Yu","year":"2014","journal-title":"Arq Bras Endocrinol Metabol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-553X.2008.01082.x","article-title":"The Red Blood Cell Distribution Width is Associated With Serum Levels of Thyroid Stimulating Hormone in the General Population","volume":"31","author":"Montagnana","year":"2009","journal-title":"Int J Lab Hematol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2013.03.008","article-title":"Thyroid Hormone Levels Are Associated With Anisocytosis in a Cohort of Euthyroid Older Outpatients","volume":"25","author":"Lippi","year":"2014","journal-title":"Eur J Intern Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2217\/bmm-2018-0476","article-title":"No Obvious Association Exists Between Red Blood Cell Distribution Width and Thyroid Function","volume":"13","author":"Wang","year":"2019","journal-title":"Biomark Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2008.10.024","article-title":"Elevated Red Blood Cell Distribution Width Predicts Mortality in Persons With Known Stroke","volume":"277","author":"Ani","year":"2009","journal-title":"J Neurol Sci"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/120.suppl_11.1451","article-title":"Quality Control in Planning and Operating the Laboratory Component for the Third National Health and Nutrition Examination Survey","author":"Gunter","year":"1990","journal-title":"J Nutr"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0480","article-title":"Thyroid Dysfunction and Anemia: A Prospective Cohort Study and a Systematic Review","volume":"28","author":"Floriani","year":"2018","journal-title":"Thyroid"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-00481","article-title":"The Relation Between Thyroid Function and Anemia: A Pooled Analysis of Individual Participant Data","volume":"103","author":"Wopereis","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-00290","article-title":"Parity and Risk of Thyroid Autoimmunity Based on the NHANES (2001-2002, 2007-2008, 2009-2010, and 2011-2012)","volume":"102","author":"Yehuda","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-01132","article-title":"Hypothyroidism and Its Association With Sleep Apnea Among Adults in the United States: NHANES 2007-2008","volume":"104","author":"Thavaraputta","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2007.08.020","article-title":"Calibration of Serum Creatinine in the National Health and Nutrition Examination Surveys (NHANES) 1988-1994, 1999-2004","volume":"50","author":"Selvin","year":"2007","journal-title":"Am J Kidney Dis"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0197","article-title":"Effect of Marijuana Use on Thyroid Function and Autoimmunity","volume":"27","author":"Malhotra","year":"2017","journal-title":"Thyroid"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2472","article-title":"Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations","volume":"167","author":"Park","year":"2017","journal-title":"Ann Intern Med"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2009.11.003","article-title":"Validation and Potential Mechanisms of Red Cell Distribution Width as a Prognostic Marker in Heart Failure","volume":"16","author":"Allen","year":"2010","journal-title":"J Card Fail"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2011.04.009","article-title":"Determinants of Red Cell Distribution Width (RDW) in Cardiorenal Patients: RDW Is Not Related to Erythropoietin Resistance","volume":"17","author":"Emans","year":"2011","journal-title":"J Card Fail"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2009.07.024","article-title":"Red Cell Distribution Width in Heart Failure: Prediction of Clinical Events and Relationship With Markers of Ineffective Erythropoiesis, Inflammation, Renal Function, and Nutritional State","volume":"158","author":"Forhecz","year":"2009","journal-title":"Am Heart J"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.5858\/133.4.628","article-title":"Relation Between Red Blood Cell Distribution Width and Inflammatory Biomarkers in a Large Cohort of Unselected Outpatients","volume":"133","author":"Lippi","year":"2009","journal-title":"Arch Pathol Lab Med"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2015.01.011","article-title":"The Association Between Muscle Strengthening Activities and Red Blood Cell Distribution Width Among a National Sample of U. S Adults","volume":"73","author":"Loprinzi","year":"2015","journal-title":"Prev Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13282","article-title":"Low Thyroid Function and Anemia in Old Age: The Leiden 85-Plus Study","volume":"63","author":"den Elzen","year":"2015","journal-title":"J Am Geriatr Soc"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.4103\/2319-4170.151032","article-title":"Prevalence and Characteristics of Anemia Associated With Thyroid Disorders in Non-Pregnant Saudi Women During the Childbearing Age: A Cross-Sectional Study","volume":"38","author":"Refaat","year":"2015","journal-title":"BioMed J"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2011.04228.x","article-title":"Significant Association Between Thyroid Hormones and Erythrocyte Indices in Euthyroid Subjects","volume":"76","author":"Bremner","year":"2012","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2012.12.004","article-title":"Thyroid Hormones and Erythrocyte Indices in a Cohort of Euthyroid Older Subjects","volume":"24","author":"Schindhelm","year":"2013","journal-title":"Eur J Intern Med"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.14310\/horm.2002.11105","article-title":"Effect of Restoration of Euthyroidism on Peripheral Blood Cells and Erythropoietin in Women With Subclinical Hypothyroidism","volume":"2","author":"Christ-Crain","year":"2003","journal-title":"Hormones (Athens)"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-1440","article-title":"Hematologic Effects of Levothyroxine in Iron-Deficient Subclinical Hypothyroid Patients: A Randomized, Double-Blind, Controlled Study","volume":"94","author":"Cinemre","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/s0025-7125(16)31963-0","article-title":"Anemia in Thyroid Diseases","volume":"59","author":"Fein","year":"1975","journal-title":"Med Clin North Am"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfg556","article-title":"Hypothyroidism and Resistance to Human Recombinant Erythropoietin","volume":"19","author":"Touam","year":"2004","journal-title":"Nephrol Dial Transplant"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.biotechadv.2019.107466","article-title":"Development of Reporter Gene Assays to Determine the Bioactivity of Biopharmaceuticals","volume":"39","author":"Wang","year":"2020","journal-title":"Biotechnol Adv"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2007.03133.x","article-title":"Total, Free and Bound Leptin and Thyroid Function in Elderly Women With Different Body Weights","volume":"68","author":"Ruscica","year":"2008","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1530\/eje.1.01903","article-title":"Cardiac Function in Borderline Hypothyroidism: A Study by Pulsed Wave Tissue Doppler Imaging","volume":"152","author":"Zoncu","year":"2005","journal-title":"Eur J Endocrinol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1055\/s-2006-949527","article-title":"Leptin Acute Modulation of the 5\u2019-Deiodinase Activities in Hypothalamus, Pituitary and Brown Adipose Tissue of Fed Rats","volume":"38","author":"Cabanelas","year":"2006","journal-title":"Horm Metab Res"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.9052","article-title":"Subclinical Hypothyroidism: A Review","volume":"322","author":"Biondi","year":"2019","journal-title":"JAMA"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.807482\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T12:30:58Z","timestamp":1642509058000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.807482\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,18]]},"references-count":49,"alternative-id":["10.3389\/fendo.2021.807482"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2021.807482","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,18]]},"article-number":"807482"}}