Graves\' Disease Presenting as Autoimmune Hemolytic Anemia

Kandinata, Stefanus Gunawan; Soelistijo, Soebagijo Adi; Amrita, Putu Niken Ayu

doi:10.12659/ajcr.930705

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…Hematological toxicities, including aplastic anemia, hemolytic anemia, thrombocytopenia, and/or neutropenia have been associated with thionamide mediations [5][6][7]. Neutropenia is defined as absolute neutrophil count (ANC) less than 1.5×10 9 /L and severe neutropenia is defined as ANC less than 0.5×10 9 /L.…”

Section: Introductionmentioning

confidence: 99%

Severe Neutropenia and Hepatotoxicity After Carbimazole Drug Therapy for Hyperthyroidism in a Pediatric Patient: A Case Report

et al. 2023

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Background:Hyperthyroidism is an overproduction of thyroid hormones. Carbimazole is an anti-thyroid medication used to treat hyperthyroidism in adults and children. It is a thionamide associated with rare adverse effects such as neutropenia, leukopenia, agranulocytosis, and hepatotoxicity. Severe neutropenia is a life-threatening event characterized by a sharp drop in absolute neutrophil count. Severe neutropenia can be treated by discontinuation of the precipitating medication. Administration of granulocyte colony-stimulating factor provides longer protection against neutropenia. Elevated liver enzymes indicate hepatotoxicity, which usually normalize after discontinuation of the offending medication. Case Report:A 17-year-old girl was treated with carbimazole since the age of 15 for hyperthyroidism secondary to Graves' disease. She initially received 10 mg of carbimazole orally twice daily. After 3 months, the patient's thyroid function reflected residual hyperthyroidism and was then up-titrated to 15 mg orally in the morning and 10 mg orally in the evening. She presented to the emergency department reporting fever, body aches, headache, nausea, and abdominal pain for 3 days. She was diagnosed with severe neutropenia and hepatotoxicity induced by carbimazole after 18 months of dose modification. Conclusions:In hyperthyroidism, it is important to maintain patients in a euthyroid state for a long period to minimize the autoimmunity and hyperthyroid relapse, which often requires long-term use of carbimazole. However, severe neutropenia and hepatotoxicity are rare and serious adverse effects of carbimazole. Clinicians should be aware of the importance to discontinuation of carbimazole, administration of granulocyte colony-stimulating factors, and supportive treatment to reverse the consequences.

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Section: Introductionmentioning

confidence: 99%

Severe Neutropenia and Hepatotoxicity After Carbimazole Drug Therapy for Hyperthyroidism in a Pediatric Patient: A Case Report

et al. 2023

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Peculiarities of the anemic syndrome course with thyroid dysfunction

Urbanovych,

Yuskiv

2023

Mìžnarodnij endokrinologìčnij žurnal

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This article was created on the basis of a literature review in the Web of Science, PubMed and Scopus databases and analyzes information on the prevalence, classification, etiopathogenetic mechanisms of anemia, evaluation of data from clinical studies and meta-analyses on the course of anemic syndrome in thyroid diseases. Anemia and thyroid dysfunction are common phenomena that often occur simultaneously. According to modern recommendations, it is worth evaluating the function of the thyroid gland when investigating anemia. With thyroid dysfunction, normocytic anemia is the most common, and microcytic and macrocytic anemias occur less often. The combination of anemia with thyroid diseases is an important problem for clinicians. Thyroid hormones have a direct effect on the proliferative capacity of the erythroid progenitor, which may be related to the mechanism of erythropoietic dysfunction in human thyroid diseases. Anemia, especially iron deficiency, in turn, affects a decrease in the level of thyroid hormones against the background of weakened thyroid function of the pituitary gland. The most frequent cause of anemia in hypothyroidism is bone marrow suppression due to thyroid hormone deficiency, as well as insufficient production of erythropoietin due to a decreased need for O2. Hyperthyroidism is associated with an increased number of erythrocytes, because there is an excessive need for tissues in oxygen, and therefore, the secretion of erythropoietin is increased. In autoimmune thyroid disease, a high prevalence of vitamin B12 deficiency and, especially, pernicious anemia is observed. Anemia in Graves’ disease resembles anemia of chronic disease and is associated with activation of nonspecific inflammation. Aplastic anemia, which is the result of the thyroid dysfunction, is rare. It occurs as a side effect in patients with autoimmune hyperthyroidism who take antithyroid drugs.

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Graves Disease (Thyroid Storm) with Polyautoimmune Disorders (Autoimmune Hemolytic Anemia and Probable Autoimmune Hepatitis)

Maherdika

Rachmawati

Setiawan

2021

Indonesian J. Clin. Pathol. Med. Lab.

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Graves' disease is caused by IgG antibodies that bind to the Thyroid Stimulating Hormone (TSH) receptor on the surfaceof the thyroid gland. These bonds drive the growth of stimulated thyroid follicular cells causing the glands to enlarge andincrease the production of thyroid hormones. Previous studies mention the association of HLA-B8 and HLA-DR3 withGraves' disease and the Cytotoxic T-lymphocyte-associated-4 (CTLA-4) gene on chromosome 2q33 as a result of reducingT-cell regulation, resulting in autoimmune disease. Autoimmune thyroid disease is often found together with otherautoimmune disorders (polyautoimmune). A 51-year-old male complained of dyspnea, yellowing of the body, and a lumpon the neck. One year ago, he was diagnosed with hyperthyroidism. Graves' disease was suspected due to a score of 22 forthe Wayne index, FT4 96.9 pmol/L, TSHs <0.01 μIU/mL, TRAb 10.8 IU/L, thyroid uptake test for toxic diffuse struma. Inaddition, the patient had atrial fibrillation and a thyroid storm with a Bruch Wartofsky index score of 65. Laboratoryexamination found normocytic normochromic anemia, thrombocytopenia, reticulocytosis, direct coomb test and autocontrol results positive one, SGOT 87 U/L, SGPT 59 U/L, alkali phosphatase 166 U/L, total bilirubin 38.13 mg/dL, directbilirubin 16.59 mg/dL, indirect bilirubin 21.54, LDH 318 U/L, establishing the diagnosis of Autoimmune Hemolytic Anemia(AIHA). Autoimmune hepatitis score: 15, so a diagnosis of probable autoimmune hepatitis was made.

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Graves\' Disease Presenting as Autoimmune Hemolytic Anemia

Cited by 3 publications

References 14 publications

Severe Neutropenia and Hepatotoxicity After Carbimazole Drug Therapy for Hyperthyroidism in a Pediatric Patient: A Case Report

Severe Neutropenia and Hepatotoxicity After Carbimazole Drug Therapy for Hyperthyroidism in a Pediatric Patient: A Case Report

Peculiarities of the anemic syndrome course with thyroid dysfunction

Graves Disease (Thyroid Storm) with Polyautoimmune Disorders (Autoimmune Hemolytic Anemia and Probable Autoimmune Hepatitis)

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