Endocrine Abstracts

Background: Immune thrombocytopenia (ITP) is an autoimmune condition where the immune system targets and destroys platelets, resulting in reduced platelet levels. The manifestations of ITP range from cases with no apparent symptoms to severe, spontaneous bleeding that can be life-threatening. ITP is differentiated into primary or secondary categories depending on its correlation with other diseases or exposure to drugs. Hashimoto’s thyroiditis is an autoimmune condition where the immune system attacks and destroys thyroid cells through both cell-mediated and antibody-mediated immune mechanisms. The coexistence of Hashimoto’s thyroiditis with immune thrombocytopenia is uncommon. In these instances, ITP may exhibit resistance to conventional first-line and second-line treatments due to a more substantial impairment in immune tolerance. We present a case of a 25-year-old male who was admitted with ITP and was found to have Hashimoto’s thyroiditis.

Case Presentation: A 25-year-old Filipino woman with no known comorbidities sought consultation at the ER due to a progressive petechial rash on bilateral lower extremities lasting for 3 days. This was associated with hematoma on the right thigh, dizziness, epistaxis, and spontaneous gum bleeding. The patient denies having colds, cough, fever, or any recent contact with sick individuals. She also denies the intake of any new medications. A complete blood count revealed a platelet count of 8, 000/ul, with a normal white blood cell count (8.6x103/ul) and hemoglobin (11.1 g/dl). Peripheral blood smear (PBS) showed thrombocytopenia with no poikilocytosis, and schistocytes were noted. Common causes of thrombocytopenia were ruled out before diagnosing ITP. The patient received an initial transfusion of 12 units of platelet concentrate, resulting in an initial increase in platelet count to 28, 500/ul. However, the following day, the platelet count decreased again to 18, 000/ul. The patient was then managed as a case of ITP and started on Dexamethasone for 4 days. A workup to rule out secondary causes of ITP was performed, including a hepatitis panel, Dengue virus test, and autoimmune disorder tests, all of which showed unremarkable results. TSH, however, was elevated at 9.844uIU/ml, with a normal fT4 at 1.1 ng/dl. Anti-TPO antibodies were also ordered and showed elevated results at 319.3 IU/ml. The patient was started on Levothyroxine and noted to have improving platelet trends. After 6 days, the patient was discharged with a platelet count of 81, 000 and a home medication of levothyroxine 1 mg. On a follow-up checkup after 1 month, TSH was now normal, and the platelet count was 395, 000.