Pancytopenia: a rare complication of Graves’ disease

Abstract

A 27-year-old male patient who presented to the emergency room with complaints of sweating, palpitations, heat intolerance, insomnia and weight loss for the last 3 months. His medical history was significant for hypertension. On examination, he was tachycardic, hypertensive, had tremors of the upper extremities and a smooth goitre with a thyroid bruit. Laboratory assessment revealed a suppressed thyroid-stimulating hormone, high free thyroxine and positive thyroid receptor antibodies. Complete blood count showed pancytopenia. As part of the work-up for pancytopenia, haptoglobin, ferritin, Coombs test, reticulocyte count hepatitis B and C antibodies were done, all of which were normal. Patient was started on methimazole, propranolol and hydrocortisone. His symptoms improved through the hospital course and he was subsequently discharged. Thyroidectomy was done once the patient's hyperthyroidism was controlled. Levothyroxine was started for the control of postsurgical hypothyroidism. Six months after thyroidectomy, the patient was euthyroid and the pancytopenia resolved.

Pancytopenia Secondary To Autoimmune Vitamin B12 Deficiency In Graves Disease

“…There have been 14 reported cases in the literature of pancytopenia associated with thyrotoxicosis in GD. Although the mechanisms remain to be fully delineated, it is hypothesized that pancytopenia results from either decreased production of hematopoietic cells or increased destruction (1). In our patient, pancytopenia nearly entirely resolved following treatment of the vitamin B 12 deficiency, while thyrotoxicosis persisted.…”

“…Graves disease (GD) is an autoimmune process in which thyrotropin receptor antibodies stimulate thyrotropin receptors on the thyroid, leading to hyperthyroidism (1). Hyperthyroidism can affect all blood cell lineages through a variety of mechanisms leading to anemia, thrombocytopenia, leukopenia, and in rare instances pancytopenia (1)(2)(3)(4)(5). Likewise, use of antithyroid drugs (ATDs) for management of thyrotoxicosis is associated with a variety of hematopoietic abnormalities including agranulocytosis and pancytopenia (6,7).…”

“…Achieving euthyroidism, or discontinuing the offending agent, often results in normalization of the hematologic disturbances. However, cytopenias in the presence of GD may in fact be attributable to co-occurring autoimmune processes such as celiac disease, pernicious anemia, or autoimmune hemolytic anemia (1,8,9).…”

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

“…GD with pancytopenia has been described rarely in literature. [456789] Single-lineage abnormalities are more common in patients with hyperthyroidism. In hyperthyroidism, anemia, leukopenia, or thrombocytopenia occurs in approximately 34%, 5.8%, and 3.3% of patients, respectively.…”

A Case of Thyrotoxicosis-induced Anemia After the Onset of Painless Thyroiditis in a Patient With Pancreatic Diabetes Mellitus: Profile of Hemoglobin, Thyroid Hormones, Soluble IL-2 Receptor, LDL-C, HDL-C and Liver Function.

“…Secondary anemia associated with hyperthyroidism is a relatively rare complication [1]. Many reports have shown that although anemia progresses with hyperthyroidism in Graves' disease, it is often transient, improving with treatment of Graves' disease [2,3].…”