A Case of Pancytopenia with Hyperthyroidism

Kim, Tae Hoon; Yoon, Ji Sung; Park, Byung Sam; Lee, Jun Young; Cho, Jaeho; Moon, Jun Sung; Kim, Eui Hyun; Won, Kyu Chang; Lee, Hyoung Woo

doi:10.12701/yujm.2013.30.1.47

Cited by 7 publications

(19 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It appears that anemia is the most associated cytopenia (10%-34%) of patients with thyrotoxicosis. [1][2][3] Leukopenia is reported in 15% to 30% of untreated thyrotoxicosis, and thrombocytopenia is rarely observed in 2% to 5% of thyrotoxicosis cases. 1,3 The association between thyrotoxicosis and pancytopenia is a rarely described in the literature (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…19 Moreover, a relative lymphocytosis with cross-antigenicity between human TSH receptors and polynuclear neutrophils has been described with formation of a characteristic blood finding of Graves disease called Kocher blood picture. 1 EMA Kyritsi et al 20 found that thyroidopathy represents the most common disorder among apparently healthy patients with mild-to-moderate neutropenia. They showed significant patterns of parameters and markers of immunity and remarkable correlations between T3 levels and absolute neutrophil counts, TSH levels and absolute CD4+ counts, T4 levels and absolute CD4+ counts.…”

Section: Discussionmentioning

confidence: 99%

“…Anemia is the most common, but other cell lineage can be affected. [1][2][3] Pancytopenia, however, is rare. This can raise a therapeutic dilemma with antithyroid drug therapies known for hematologic side effects.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Graves Disease Causing Pancytopenia: Case Report and Literature Review

Pincet

Gorostidi

2018

Clin Med Insights Case Rep

View full text Add to dashboard Cite

Background:Graves disease or other causes of thyrotoxicosis are frequently associated with cytopenia. Although anemia is the most common, other cell lineage can be affected. Pancytopenia is a rare complication of thyrotoxicosis.Case presentation:We report a case of a 33-year-old Chinese man who presented a nonsevere pancytopenia in the context of a newly diagnosed Graves disease. Restauration of euthyroid state led to progressive correction of pancytopenia.Conclusions:Literature review shows other rare cases of pancytopenia. It is usually nonsevere with just extremely rare cases of transfusion reported. Evolution was always favorable after achievement of euthyroid state. Its mechanism remains poorly understood, especially because those patients have no vitamin or iron deficiency. The exact physiopathological process remains unclear but 2 causes seem to overlap: reduced production of hematopoietic cells from the bone marrow and increased destruction or sequestration of mature hematopoietic cells. Despite unclear mechanism, the presence of hematologic abnormalities including pancytopenia must not be considered as a contraindication to antithyroid drug therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Graves Disease Causing Pancytopenia: Case Report and Literature Review

Pincet

Gorostidi

2018

Clin Med Insights Case Rep

View full text Add to dashboard Cite

show abstract

“…However, single lineage abnormalities (anemia, leukopenia, or thrombocytopenia) are more common in patients with hyperthyroidism (34%, 5.8%, and 3.3%, resp.) [ 5 , 10 ]. Leukopenia with a relative lymphocytosis is not an uncommon blood abnormality in GD, named “Kocher's blood picture.” [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Atypical Complications of Graves’ Disease: A Case Report and Literature Review

Baagar

Siddique

Arroub

et al. 2017

Case Reports in Endocrinology

View full text Add to dashboard Cite

Graves' disease (GD) may display uncommon manifestations. We report a patient with rare complications of GD and present a comprehensive literature review. A 35-year-old woman presented with a two-week history of dyspnea, palpitations, and edema. She had a raised jugular venous pressure, goiter, and exophthalmos. Laboratory tests showed pancytopenia, a raised alkaline phosphatase level, hyperbilirubinemia (mainly direct bilirubin), and hyperthyroidism [TSH: <0.01 mIU/L (reference values: 0.45–4.5), fT4: 54.69 pmol/L (reference values: 9.0–20.0), and fT3: >46.08 pmol/L (reference values: 2.6–5.7)]. Her thyroid uptake scan indicated GD. Echocardiography showed a high right ventricular systolic pressure: 60.16 mmHg. Lugol's iodine, propranolol, cholestyramine, and dexamethasone were initiated. Hematologic investigations uncovered no reason for the pancytopenia; therefore, carbimazole was started. Workup for hepatic impairment and pulmonary hypertension (PH) was negative. The patient became euthyroid after 3 months. Leukocyte and platelet counts and bilirubin levels normalized, and her hemoglobin and alkaline phosphatase levels and right ventricular systolic pressure (52.64 mmHg) improved. This is the first reported single case of GD with the following three rare manifestations: pancytopenia, cholestatic liver injury, and PH with right-sided heart failure. With antithyroid drugs treatment, pancytopenia should resolve with euthyroidism, but PH and liver injury may take several months to resolve.

show abstract

“…The hematopoietic system is greatly affected by the thyroid state, and thyrotoxicosisinduced changes can affect all three hematopoietic cell lineages. The most common presentation is anemia [2]. Pancytopenia has been reported in few cases in the literature, and most cases were related to Graves' disease, but they are not usually catastrophic [3].…”

Section: Discussionmentioning

confidence: 99%

Graves’ Disease-Related Pancytopenia Improved after Radioactive Iodine Ablation

et al. 2020

View full text Add to dashboard Cite

Graves' disease is an autoimmune disease that affects the thyroid glands which often results in enlarged thyroid glands, and it is the most common cause of clinical hyperthyroidism especially in young patients. Radioiodine ablation is a radiation therapy in which radioactive iodine is administered to destroy or ablate thyroid cells. It is commonly used for the treatment of Graves' disease. We report on a 39-year-old male, who presented with Graves' disease, found to have pancytopenia and hypocellular bone marrow. Pancytopenia is a rare complication of thyrotoxicosis that is usually not severe and does not require supportive blood product transfusions. Our patient was treated with antithyroid medications followed by radioactive iodine ablation followed by a spontaneous recovery of pancytopenia.

show abstract

A Case of Pancytopenia with Hyperthyroidism

Cited by 7 publications

References 11 publications

Graves Disease Causing Pancytopenia: Case Report and Literature Review

Graves Disease Causing Pancytopenia: Case Report and Literature Review

Atypical Complications of Graves’ Disease: A Case Report and Literature Review

Graves’ Disease-Related Pancytopenia Improved after Radioactive Iodine Ablation

Contact Info

Product

Resources

About