Hyperthyroidism with concurrent FMS-like tyrosine kinase 3-internal tandem duplication-positive acute promyelocytic leukemia: A case report and review of the literature

Abstract

Neutropenia is a common side-effect in hyperthyroid patients with long-term use of antithyroid drugs. This may be caused by drug-induced immune dysfunction or increased thyroxine hematologic toxicity, which usually returns to normal after medication is discontinued or the hyperthyroidism becomes well controlled. However, hyperthyroidism with pancytopenia is extremely rare. The current case report presents a hyperthyroid patient complicated with pancytopenia who had taken antithyroid drugs for 14 years. Bone marrow analysis revealed primary leuokocytes, indicating M3 acute leukemia. Genetic analysis revealed promyelocytic leukemia-retinoic acid receptor α fusion and FMS-like tyrosine kinase 3-internal tandem duplication. The genetic abnormality was also associated with thyroid hormonal functions. After a standard anti-M3 regimen was administed, the patient achieved complete remission and maintained stable thyroid functions. To the best of our knowledge, this is the first reported case of a patient with hyperthyroidism acquiring M3 leukemia harboring the FMS-like tyrosine kinase 3-internal tandem duplication.

A retrospective analysis of 1,231 patients with anemia after surgical treatment of hyperthyroidism

“…Retrospective analysis of 1,231 patients with moderate postoperative anemia showed that incidence of postoperative anemia in female patients was slightly higher than that in male patients, but there was no significant difference, which is consistent with the findings reported by Jiang et al ( 15 ). Hyperthyroidism may occur in all age groups, but mainly affects patients between 20–40 years.…”

“…In the process of data collection, we found that anemia may occur in patients with different pathological types and different surgical treatments, while surgery methods showed no significant effects on the occurrence of postoperative anemia, but pathological types showed significant effects on the occurrence of postoperative anemia. The causes of anemia after surgical treatment of hyperthyroidism patients are still unclear, and may be related to the following factors: Reduction of thyroid hormone production may lead to reduced erythropoietin, which in turn causes anemia; emergence of erythrocyte-dependent antibodies after surgery, leading to hemolytic anemia; FT3 or FT4, and TSH may be involved in postoperative anemia in patients with hyperthyroidism; autoimmune factors ( 15 – 18 ). M'Rabet-Bensalah et al ( 19 ) showed a higher prevalence of anemia in patients with hyperthyroidism, but the incidence of anemia was not increased in patients with subclinical thyroid insufficiency, which may be related to the degree of subclinical thyroid dysfunction.…”