Does sucrosomial iron bypass hepcidin blocking in patients with Hashimoto's (Hashimoto's thyroiditis) flareup?

Sucrosomial Iron in Hashimoto's Thyroiditis: Bypassing Hepcidin Blockade

Yes, sucrosomial iron can bypass hepcidin-mediated iron blockade in patients with Hashimoto's thyroiditis flare-ups, making it a potentially effective treatment option for iron deficiency in these patients.

Understanding Hepcidin in Hashimoto's Thyroiditis

• Hashimoto's thyroiditis is an autoimmune condition characterized by lymphomonocytic inflammation of the thyroid gland, which can be associated with iron deficiency 1
• During inflammatory conditions like Hashimoto's flare-ups, hepcidin levels increase, blocking iron absorption from the intestine and iron release from macrophages, leading to functional iron deficiency 2
• Hepcidin acts by binding to ferroportin (the iron exporter protein), causing its internalization and degradation, which blocks cellular iron export and decreases serum iron levels 3
• This hepcidin-mediated iron blockade is a key mechanism in anemia of inflammation, which can occur during autoimmune flares 3

Sucrosomial Iron: Mechanism of Action

• Sucrosomial iron consists of ferric pyrophosphate conveyed by a phospholipid and sucrester matrix (sucrosome) that protects iron from the harsh gastric environment 4
• Unlike conventional oral iron formulations, sucrosomial iron absorption occurs through alternative pathways:
  • It is absorbed mostly as intact particles through both paracellular and transcellular routes 4
  • Absorption is mediated by both enterocytes and M cells, bypassing the conventional DMT1-dependent pathway that is regulated by hepcidin 4

Evidence Supporting Hepcidin Bypass

• Animal studies have shown that sucrosomial iron can correct anemia without inducing hepcidin expression, unlike ferrous sulfate which significantly increases hepcidin levels 5
• Sucrosomial iron was found to restore iron stores in anemic mice without triggering inflammatory markers (Socs3, Saa1, IL6, and CRP), which are typically elevated with conventional iron supplementation 5
• The unique absorption mechanism of sucrosomial iron allows it to overcome the hepcidin block that occurs during inflammatory conditions like Hashimoto's flare-ups 4

Clinical Implications for Hashimoto's Patients

• Iron is essential for proper thyroid peroxidase (TPO) function, an enzyme crucial for thyroid hormone production, making iron status particularly important in Hashimoto's thyroiditis 1
• Patients with Hashimoto's disease often have elevated inflammatory markers and potentially increased hepcidin levels, which can impair conventional oral iron absorption 6
• Sucrosomial iron may be particularly beneficial for Hashimoto's patients during flare-ups when inflammation is high and conventional iron absorption is compromised 4
• The excellent gastrointestinal tolerance of sucrosomial iron compared to oral iron salts makes it a suitable option for long-term use in chronic conditions like Hashimoto's thyroiditis 4

Treatment Considerations

• Assessment of iron status, including ferritin levels, should be an integral part of diagnostic measures in cases of hypothyroidism, particularly Hashimoto's disease 1
• For Hashimoto's patients with iron deficiency during flare-ups, sucrosomial iron may be preferable to conventional oral iron due to its ability to bypass hepcidin blockade 4
• Intravenous iron has traditionally been used for patients with inflammatory conditions and iron deficiency, but sucrosomial iron offers a less invasive alternative with fewer side effects 4
• Monitoring both thyroid function and iron parameters is important during treatment, as improving iron status may positively affect thyroid peroxidase activity 1

Potential Advantages Over Conventional Iron Therapy

• Sucrosomial iron does not induce inflammatory responses that are typically seen with ferrous sulfate supplementation 5
• The formulation allows for higher intestinal absorption and excellent gastrointestinal tolerance compared to conventional oral iron salts 4
• It may be effective even in conditions of elevated hepcidin, where traditional oral iron preparations often fail 4
• Sucrosomial iron represents a cost-effective alternative to intravenous iron therapy for patients with inflammatory conditions like Hashimoto's thyroiditis 4