Graves Disease Causing Pancytopenia: Case Report and Literature Review

Pincet, Laurence; Gorostidi, François

doi:10.1177/1179547618781090

Cited by 10 publications

(26 citation statements)

References 16 publications

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“…Pancytopenia is a rare complication of GD thought to be secondary to thyrotoxicosis, immune-mediated destruction, sequestration, and vitamin deficiency (1). Thyrotoxicosis is supported by the observation that pancytopenia is also seen in the setting of multinodular goiter and Hashimoto thyroiditis (1,2). As in this case, treatment of the hyperthyroidism causes resolution of pancytopenia (1,2).…”

Section: Discussionsupporting

confidence: 57%

“…Thyrotoxicosis is supported by the observation that pancytopenia is also seen in the setting of multinodular goiter and Hashimoto thyroiditis (1,2). As in this case, treatment of the hyperthyroidism causes resolution of pancytopenia (1,2). Some patients may require transfusions of red blood cells or platelets and vitamin B12 supplementation (2).…”

Section: Discussionmentioning

confidence: 68%

“…As in this case, treatment of the hyperthyroidism causes resolution of pancytopenia (1,2). Some patients may require transfusions of red blood cells or platelets and vitamin B12 supplementation (2).…”

Section: Discussionmentioning

confidence: 71%

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Pancytopenia and Lymphoid Organ Hyperplasia in a Patient with Graves Disease: Response to Antithyroid Drug Therapy

Nandiraju

Jabbour

et al. 2019

AACE Clinical Case Reports

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Objective: In rare instances, cytopenias manifest as a complication of thyrotoxicosis. Here, we report a case of Graves disease (GD) thyrotoxicosis presenting as pancytopenia that resolved with antithyroid therapy. Methods: A 35-year-old male presented with fever and chills following an outpatient colonoscopy. Initial blood work revealed pancytopenia. Workup included viral antigen titers, blood cultures, rheumatologic antibodies, inflammatory markers, immunocompetency, nutrient deficiency, metal toxicity, and malignancy. Bone marrow aspirate was analyzed by microscope, flow cytometry, fluorescence in situ hybridization, and genetic analysis. Computed tomography scan of the chest, abdomen, and pelvis was obtained. Thyroid labs included thyroid-stimulating hormone, total triiodothyronine, free thyroxine, thyroid-stimulating immunoglobulin, anti-thyroid peroxidase antibody, and radioiodine uptake scan. Results: All workup above was non-revelatory except as follows. Imaging revealed thymic hyperplasia and splenomegaly. Thyroid labs revealed thyroid-stimulating hormone <0.02 μIU/mL (reference range is 0.30 to 5.00 μIU/mL), free thyroxine of 4.7 ng/dL (reference range is 0.7 to 1.7 ng/dL), total triiodothyronine of 191 pg/mL (reference range is 90 to 180 pg/mL), thyroid-stimulating immunoglobulin of 522% (reference range is <140%). Bone marrow biopsy was consistent with a reactive process suggesting an infectious or autoimmune process. Radioiodine uptake scan confirmed GD. He was discharged on antithyroid medication. Two-month follow-up labs revealed improved cell counts; his absolute neutrophil count was 1.94 × 109 cells/L (reference range is 1.50 to 8.00 × 109 cells/L), hemoglobin was 12.9 g/dL (reference range is 14.0 to 17.0 g/dL), and platelets were 153 × 109 cells/L (reference range is 140 to 400 × 109 cells/L). Definitive treatment was obtained with 12 mCi of 131-iodine. Conclusion: Pancytopenia and lymphoid organ hyperplasia (splenomegaly, thymic hyperplasia, and lymphadenopathy) have been previously reported to be associated with thyrotoxicosis secondary to GD, rarely simultaneously, and manifest from both thyrotoxic and immunologic mechanisms. After excluding alternative life-threatening pathologies, in such presentations, GD should be considered and treated if confirmed.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 68%

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Pancytopenia and Lymphoid Organ Hyperplasia in a Patient with Graves Disease: Response to Antithyroid Drug Therapy

Nandiraju

Jabbour

et al. 2019

AACE Clinical Case Reports

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“…On the other hand, hyperthyroidism leads to a (usually mild) decrease in total white blood cell count, neutropenia and thrombocytopenia [11, 23, 24]. Pancytopenia and autoimmune haemolytic anaemia are rare complications of thyroid hormone excess [21, 22].…”

Section: Introductionmentioning

confidence: 99%

Peripheral blood picture and aminotransferase activity in children with newly diagnosed Graves’ disease at baseline and after the initiation of antithyroid drug therapy

Artemniak-Wojtowicz

Witkowska–Sędek

Borowiec

et al. 2019

cejoi

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Aim of the study: Assessment of the peripheral blood picture and aminotransferase activity in children with newly diagnosed Graves' disease (GD) at baseline and 4-6 weeks after the initiation of antithyroid drug (atD) therapy. Material and methods: Data of 59 children were assessed retrospectively. Baseline analysis included concentrations of thyroid-stimulating hormone (tsH), free triiodothyronine (ft3), free thyroxine (ft4), tsH receptor antibodies (tsH-r ab), complete blood cell count (cBc), aspartate (ast) and alanine aminotransferase (alt) activity. reassessment of cBc and aminotransferase activity was performed 4-6 weeks after the initiation of atD therapy. Results: significant decreases in the neutrophil count, mcV, haemoglobin (Hgb), red blood cell (rBc) count, white blood cell (WBc) count and platelet (Plt) count were found in 37.3%, 32.2%, 22%, 13.6%, 8.5% and 5% of untreated patients, respectively. increased baseline alt and ast activity was observed in 44% and 32.2% of children, respectively. initiation of atD therapy led to significant changes in Hgb, rBc and Plt count, rDW and alt activity. negative associations between tsH-r ab, tsH and mcV were found. alt and ast activity were negatively related to baseline tsH levels. alt activity was also associated with baseline ft4 and ft3. Conclusions: The incidence of haematopoiesis and liver abnormalities in GD children seems to be similar to that reported in adult patients. the most common alterations are changes in neutrophil count, rBc parameters and alt activity. the initiation of atD therapy usually leads to significant improvement in those parameters.

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“…As in the present case, in all the reported cases, pancytopenia was corrected after correction of thyrotoxicosis irrespective of the chosen treatment modalities. [17]…”

Section: Discussionmentioning

confidence: 99%

Graves' disease with pancytopenia and hepatic dysfunction: A rare case presentation

2019

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Graves Disease Causing Pancytopenia: Case Report and Literature Review

Cited by 10 publications

References 16 publications

Pancytopenia and Lymphoid Organ Hyperplasia in a Patient with Graves Disease: Response to Antithyroid Drug Therapy

Pancytopenia and Lymphoid Organ Hyperplasia in a Patient with Graves Disease: Response to Antithyroid Drug Therapy

Peripheral blood picture and aminotransferase activity in children with newly diagnosed Graves’ disease at baseline and after the initiation of antithyroid drug therapy

Graves' disease with pancytopenia and hepatic dysfunction: A rare case presentation

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