Successful Remission of Evans Syndrome Associated with Graves' Disease by Using Propylthiouracil Monotherapy

Ushiki, Takashi; Masuko, Masayoshi; Nikkuni, Koji; Terukina-Yoshida, Jun; Momotsu-Nanba, Ayako; Morikawa, Hiroshi; Usami, Akio; Fuse, Ichiro; Toba, Kenji; Takai, Kazue; Aizawa, Yoshifusa

doi:10.2169/internalmedicine.50.4319

Cited by 10 publications

(8 citation statements)

References 20 publications

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“…Although in about half of the cases the cause is unknown, autoimmune response and exposure to certain drugs, chemicals, or radiation our knowledge, so far 4 cases have been described in the literature. 72 Both Evans syndrome and AITD may share common immunological background. Insufficient suppressor T-cell activity and anti-TSH receptor autoantibodies, such as oligoclonal immunoglobulin G2 antibodies, are listed as potential pathogenetic factors.…”

Section: Autoimmune Hemolytic Anemia and Evans Syndromementioning

confidence: 99%

Anemia in thyroid diseases

Szczepanek‐Parulska¹,

Hernik²,

Ruchała³

2017

Polish Archives of Internal Medicine

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Section: Autoimmune Hemolytic Anemia and Evans Syndromementioning

confidence: 99%

Anemia in thyroid diseases

Szczepanek‐Parulska¹,

Hernik²,

Ruchała³

2017

Polish Archives of Internal Medicine

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“…Pernicious anemia and celiac disease are each seen in about 1% of GD patients [4] but AIHA occurs less frequently and is limited to single case reports [6]. AIHA in the setting of GD can happen alone [7–10] or along with immune thrombocytopenic purpura, as a part of Evan's syndrome [11, 12]. The exact pathophysiology remains unclear but seems to be related to both hyperthyroidism and autoimmunity.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, one can postulate that increased thyroid activity in hyperthyroid patients is also a direct result of increased autoimmunity in GD. Nevertheless, AIHA has been successfully treated in some patients solely by antithyroid medications (propylthiouracil) without glucocorticoids [10, 11], which emphasizes the role of hyperthyroidism. Regardless of pathophysiology, AIHA in the setting of GD generally responds well to treatment.…”

Section: Discussionmentioning

confidence: 99%

Graves’ Disease Causing Pancytopenia and Autoimmune Hemolytic Anemia at Different Time Intervals: A Case Report and a Review of the Literature

Naji

Kumar

Dewani

et al. 2013

Case Reports in Medicine

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Graves' disease (GD) is associated with various hematologic abnormalities but pancytopenia and autoimmune hemolytic anemia (AIHA) are reported very rarely. Herein, we report a patient with GD who had both of these rare complications at different time intervals, along with a review of the related literature. The patient was a 70-year-old man who, during a hospitalization, was also noted to have pancytopenia and elevated thyroid hormone levels. Complete hematologic workup was unremarkable and his pancytopenia was attributed to hyperthyroidism. He was started on methimazole but unfortunately did not return for followup and stopped methimazole after a few weeks. A year later, he presented with fatigue and weight loss. Labs showed hyperthyroidism and isolated anemia (hemoglobin 7 g/dL). He had positive direct Coombs test and elevated reticulocyte index. He was diagnosed with AIHA and started on glucocorticoids. GD was confirmed with elevated levels of thyroid stimulating immunoglobulins and thyroid uptake and scan. He was treated with methimazole and radioactive iodine ablation. His hemoglobin improved to 10.7 g/dL at discharge without blood transfusion. Graves' disease should be considered in the differential diagnosis of hematologic abnormalities. These abnormalities in the setting of GD generally respond well to antithyroid treatment.

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“…It appears that autoimmune haemolytic anemia is much less commonly found in association with GD when compared with immune thrombocytopenia and pernicious anemia [24]. In some of the case reports, autoimmune haemolytic anemia was present as a part of Evans' syndrome (autoimmune haemolytic anemia and idiopathic thrombocytopenic purpura) in association with GD [25, 26]. In the study by Rajic et al, on 362 subjects with autoimmune haematological disorders, there was no evidence of simultaneous autoimmune thyroid disease in the subgroup of patients with autoimmune haemolytic anemia [24].…”

Section: Anemiamentioning

confidence: 99%

“…Ikeda et al reported a case of Evans' syndrome in a patient with GD that was not hyperthyroid after treatment with radioiodine, and suggested that an underlying immunological mechanism could be responsible for the association [25]. In this regard it was very interesting to get an effective control of hemolysis with the use of an antithyroid drug alone (namely, propylthiouracil) that was observed in a case of autoimmune haemolytic anemia [20], and in another one with Evan's syndrome [26]. This finding might be related to the earlier observation that microsomal antibodies and TSH receptor antibodies decreased in parallel, while patients with GD were taking carbimazole, whereas no significant changes were observed during treatment with placebo or propranolol [27].…”

Section: Anemiamentioning

confidence: 99%

Atypical Clinical Manifestations of Graves' Disease: An Analysis in Depth

Hegazi

Ahmed

2012

Journal of Thyroid Research

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Over the past few decades, there has been an increase in the number of reports about newly recognized (atypical or unusual) manifestations of Graves' disease (GD), that are related to various body systems. One of these manifestations is sometimes the main presenting feature of GD. Some of the atypical manifestations are specifically related to GD, while others are also similarly seen in patients with other forms of hyperthyroidism. Lack of knowledge of the association between these findings and GD may lead to delay in diagnosis, misdiagnosis, or unnecessary investigations. The atypical clinical presentations of GD include anemia, vomiting, jaundice, and right heart failure. There is one type of anemia that is not explained by any of the known etiological factors and responds well to hyperthyroidism treatment. This type of anemia resembles anemia of chronic disease and may be termed GD anemia. Other forms of anemia that are associated with GD include pernicious anemia, iron deficiency anemia of celiac disease, and autoimmune hemolytic anemia. Vomiting has been reported as a presenting feature of Graves' disease. Some cases had the typical findings of hyperthyroidism initially masked, and the vomiting did not improve until hyperthyroidism has been detected and treated. Hyperthyroidism may present with jaundice, and on the other hand, deep jaundice may develop with the onset of overt hyperthyroidism in previously compensated chronic liver disease patients. Pulmonary hypertension is reported to be associated with GD and to respond to its treatment. GD-related pulmonary hypertension may be so severe to produce isolated right-sided heart failure that is occasionally found as the presenting manifestation of GD.

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Successful Remission of Evans Syndrome Associated with Graves' Disease by Using Propylthiouracil Monotherapy

Cited by 10 publications

References 20 publications

Anemia in thyroid diseases

Anemia in thyroid diseases

Graves’ Disease Causing Pancytopenia and Autoimmune Hemolytic Anemia at Different Time Intervals: A Case Report and a Review of the Literature

Atypical Clinical Manifestations of Graves' Disease: An Analysis in Depth

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