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Additionally, TPO-Ab enhance pro-inflammatory cytokine responses to TPO in mononuclear cells (20), contributing to inflammation and extra-thyroidal diseases (49).Ott et al., demonstrated that elevated pre-operative TPO-Ab levels were significantly associated with fatigue, irritability, and reduced QoL in euthyroid patients undergoing surgery for benign goitre (18)

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Hemoglobin's affinity for oxygen is also affected by the patient's pH, PaCO 2 , body temperature, and level of 2,3-bisphosphoglycerate (BPG, also called diphosphoglycerate, a substance in red blood cells)

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