ECE2015 Eposter Presentations Thyroid (non-cancer) (160 abstracts)
Co-occurrence of Graves' disease and immune thyrombocytopenia: a case report
Mehmet Muhittin Yalcin 1 , Emre Arslan 1 , Fusun Balos Toruner 1 , Alev Altinova 1 , Mujde Akturk 1 , Burak Dumludag 2 , Munci Yagci 3 , Ilhan Yetkin 1 & Metin Arslan 1
1Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey; 2Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey; 3Department of Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey.
Also cytopenies can be established in the evaluation of Graves’ disease (GD), isolated thrombocytopenia is very rare. Here, we present a case of immune thrombocytopenia incidentally found in the evaluation of GD. A 48-year-old female was admitted to our hospital with palpitation and anxiousness. The thyroid function tests were concordant with thyrotoxicosis. She had two subcentimetre nodules in the right thyroid lobe. Thyroid gland had increased iodine uptake. And thyroid scan showed a diffuse hyperactive thyroid gland. GD was diagnosed. She had isolated thyrombocytopenia in her complete blood count (37 000/μl). She had no history of bleeding, chronic illness, medication, or herbal drugs. Peripheral smear was concordant with platelet count. Her haemoglobin level was normal. Antinuclear antibody was negative. Immune thrombocytopenia was diagnosed. As she had platelet levels above 20 000/ml we decided to initially start methimazole therapy without steroid therapy. In the first month of methimazole therapy, platelet counts were defined between 25 000 and 45 000/μl. But 6 weeks after methimazole therapy, when her free T4 and free T3 levels were in the normal range, her platelet count began to decrease. Prednisolone treatment was initiated for immune thrombocytopenia. Platelet count rapidly increased to normal levels. Steroid therapy gradually tapered and stopped after two months. Four months after discontinuing steroid treatment, she is now euthyroid with methimazole therapy, and her platelet count is fluctuating between 100 000 and 120 000/μl.
Discussion: There were only a few case reports describing co-occurrence of GD and immune thrombocytopenia. A hypothesis of cross reaction between antithyroid antibodies and platelet epitopes were discussed. Although some literature supported this hypothesis, others did not. In our case report methimazole treatment was failed for improving platelet count despite successful normalisation of free thyroid hormone levels.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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