J Korean Endocr Soc.  2009 Dec;24(4):272-276. 10.3803/jkes.2009.24.4.272.

A Case of Graves' Disease with Pancytopenia

• Shin JH
• Kim HJ
• Kim SB
• Kim DP
• Ko BS
• Kim DS
• Kim JM
• Gong SJ
• Lee JA

• KMID: 1468547
• DOI: http://doi.org/10.3803/jkes.2009.24.4.272

Abstract

Hematological disorders, and especially single lineage abnormalities, have been described in patients suffering with thyrotoxicosis, but pancytopenia is a rare complication of thyrotoxicosis. Pancytopenia with thyrotoxicosis has been reported to be totally reversible with antithyroid drug treatment. We experienced a case with pancytopenia associated with Graves' disease in a 57-year-old woman who had no specific cause of pancytopenia. She presented with dyspnea and palpitation. The laboratory findings revealed thyrotoxicosis and pancytopenia. Increased radioisotope uptake was seen on the thyroid scan and normal cellularity and maturation were found in the bone marrow aspiration biopsy. Based on these findings, she was diagnosed as suffering from Gravesyendisease with pancytopenia. After treatment with propylthiouracil, the blood cell counts were restored to normal as the patient achieved a euthyroid state. We report here on a case of Graves' disease that was complicated by pancytopenia, and all this was normalized after treatment for hyperthyroidism.

Keyword

Graves' disease; pancytopenia; thyrotoxicosis

MeSH Terms

Biopsy, Needle
Blood Cell Count
Bone Marrow
Dyspnea
Female
Graves Disease
Humans
Hyperthyroidism
Middle Aged
Pancytopenia
Propylthiouracil
Stress, Psychological
Thyroid Gland
Thyrotoxicosis
Propylthiouracil

Figure

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  Fig. 1 A. Bone marrow biopsy (H&E stain, ×100). Bone marrow biopsy shows normal cellularity. B. Bone marrow aspiration smear (Wright-Giemsa stain, ×400). Bone marrow aspiration smear shows normal hematopoiesis without abnormal cell infiltration.

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  Fig. 2 A. Chest PA. Chest PA shows cardiomegaly and multiple calcified nodules and fibrosis on both upper lobes representing sequelae of old pulmonary tuberculosis. B. Abdomen CT scan. Abdomen CT scan does not show splenomegaly.

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  Fig. 3 Thyroid scan. Thyroid scan shows asymmetric thyroid enlargement and heterogeneously increased radioisotope uptake.

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  Fig. 4 Clinical course. Antihyperthyroid therapy (PTU 300 mg daily p.o.) was initiated at the time of diagnosis of Graves disease. T3 and fT4 concentration were slowly normalized with restoration of pancytopenia for 3 months. FT4, free T4; T3, total T3; TSH, thyroid stimulating hormone; WBC, white blood cell; Hb, hemoglobin, Plt: platelet.

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