Thyrotoxicosis in Pregnancy Presenting as Pancytopenia

Abstract

Delay in diagnosis of thyroid disease can result in morbidity and mortality. Thyroid disorders are not uncommon in the reproductive age group and therefore in pregnancy; recognition of both the common and the more unusual manifestations will optimize outcome.

Treatment of hyperthyroidism with antithyroid drugs corrects mild neutropenia in Graves' disease

“…Previous studies have reported the prevalence of neutropenia in hyperthyroidism to be between 15% and 30% . In addition, small studies and a few case reports have also shown normalization of neutrophil counts with normalization of thyroid function . These reports were based on small numbers of patients and did not assess other factors associated with neutrophil counts in hyperthyroidism.…”

“…13,14 In addition, small studies and a few case reports have also shown normalization of neutrophil counts with normalization of thyroid function. 7,[13][14][15][16] These reports were based on small numbers of patients and did not assess other factors associated with neutrophil counts in hyperthyroidism. Our study of neutrophil counts has collected data in a prospective and systematic manner in patients at baseline, prior to ATD therapy, and after achieving euthyroidism.…”

Pancytopenia in the first trimester: An indicator of hidden hyperthyroidism

“…True hyperthyroidism is rarely complicated with pancytopenia; to the best of our knowledge, only 10 cases including our current case have been reported (Table ) . In our case, a blood laboratory examination performed at 9 GW (at admission due to severe hyperemesis gravidarum) detected pancytopenia, and subsequent investigation of the causes of the patient's pancytopenia resulted in the diagnosis of hyperthyroidism.…”

“…Pancytopenia is a complication of hyperthyroidism, but it is very rare. Although hyperemesis gravidarum is often associated with the occurrence of transient hyperthyroidism, to the best of our knowledge, no cases of transient hyperthyroidism during pregnancy complicated with pancytopenia have been reported. To rule out the possibility of transient hyperthyroidism, we measured the patient's TSH receptor antibody level and found that it was significantly increased, which resulted in a diagnosis of hidden hyperthyroidism.…”

“…Although hyperthyroidism is a common complication in women of reproductive age, it rarely occurs in combination with pancytopenia . Transient hyperthyroidism in the first trimester (i.e, gestational thyrotoxicosis) is sometimes complicated with hyperemesis gravidarum mainly due to an increase in the circulating levels of human chorionic gonadotropin, but it rarely requires treatment .…”