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

Behera, Kishore Kumar; Agrawal, Kanhaiyalal; Adhya, Amit Kumar

doi:10.4103/ijnm.ijnm_134_18

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…Several studies have reported not only neutropenia but pancytopenia as a complication of poorly controlled Graves’ disease ( 3 , 4 , 5 , 7 , 8 , 10 , 20 , 21 , 22 , 23 , 24 ) which responded to ATDs, with or without RAI. In one case report ( 10 ), although pancytopenia improved with ATDs, there was a recurrent increase in thyroid hormone levels and pancytopenia after four months, upon which subtotal thyroidectomy was performed.…”

Section: Discussionmentioning

confidence: 99%

“…This has been reported several times in the literature, generally in the adult population. Most of these patients were treated with thionamides, with blood counts improving after achievement of euthyroidism ( 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ). In particular, the presence of baseline neutropenia in a patient presenting with hyperthyroidism could be worrisome for the clinician, given the concern for potential agranulocytosis as a side effect of ATDs.…”

Section: Introductionmentioning

confidence: 99%

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Pre-treatment Neutropenia in Children and Adolescents with Autoimmune Hyperthyroidism

Litao¹,

Alvarez²,

Shah³

2021

Jcrpe

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Objective: Neutropenia can occur in untreated autoimmune hyperthyroidism (AIH) or in association with treatment with the anti-thyroid drug, methimazole (MMI). Starting MMI in children and adolescents with AIH and pre-existing neutropenia could thus be worrisome. The aim was to describe the prevalence of neutropenia in pediatric AIH, prior to antithyroid drug therapy and to assess the effect of antithyroid drugs on neutrophil count. Methods: Patients with AIH attending a pediatric endocrinology clinic were retrospectively reviewed. Absolute neutrophil count (ANC) data at presentation and during anti-thyroid treatment for up to 24 weeks was collected. AIH was defined as elevated free thyroxine (fT4) or free tri-iodothyronine (fT3), suppressed thyroid stimulating hormone, and positive thyroid autoantibodies. Neutropenia was defined as ANC <1500 cells/μL. Results: Thirty-one patients (71% female) were included with a median interquartile range (IQR) age of 14.71 (11.89-17.10) years. Neither fT4 nor fT3 levels correlated with ANC at presentation (r s =0.22, p=0.24 and r s =0.13, p=0.54, respectively). 26/31 (84%) had normal baseline ANC. None developed neutropenia with thionamides. 5/31 (16%) had baseline neutropenia (median ANC 1,200/μL; IQR 874-1200). Four of these five started MMI at diagnosis while one was started on propranolol only but MMI was started one week later. All five normalized ANC within 24 weeks. Conclusion: In this cohort, 16% of AIH patients had neutropenia at presentation, but this resolved in the short term and did not worsen with thionamides. Thionamides may be used with caution in these patients with close monitoring of blood counts.

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