J Korean Soc Endocrinol.  2005 Jun;20(3):289-293. 10.3803/jkes.2005.20.3.289.

A Case of Graves' Disease associated with Idiopathic Thrombocytopenic Purpura

• Kim WH
• Choi EK
• Yoon SH
• Jeong IB
• Cho DY
• Park KY

• KMID: 2200571
• DOI: http://doi.org/10.3803/jkes.2005.20.3.289

Abstract

The association of Graves' disease and idiopathic thrombocytopenic purpura(ITP) is a rather rare, but well documented condition, and has also been reported a few times in Korea. At present, two main hypothetical mechanisms are used to explain the association of the two diseases; the presence of autoimmunity, which leads to both diseases, and activation of the reticuloendothelial system by thyroid hormone. A 33 year old female patient visited our hospital with mucosal bleeding and purpura over her entire body of 3 days duration. Her initial platelet count was 2x109/L, and the thyroid function tests showed a suppressed TSH level of 0.09 mU/L(0.4~3.1) and elevated levels of triiodothyronine and free thyroxine. The levels of anti-thyroglobulin Ab anti-TPO Ab, and anti-TSH receptor Ab were also elevated. The clinical, laboratory and bone marrow findings were compatible with Graves' disease associated with ITP. She was treated with methylprednisolone and propylthiouracil, after which her platelet count increased and thyroid function normalized. We report a case of Graves' disease associated with ITP, which was treated well by glucocorticoid and antithyroid medications

MeSH Terms

Adult
Autoimmunity
Bone Marrow
Female
Graves Disease*
Hemorrhage
Humans
Korea
Methylprednisolone
Mononuclear Phagocyte System
Platelet Count
Propylthiouracil
Purpura
Purpura, Thrombocytopenic, Idiopathic*
Thyroid Function Tests
Thyroid Gland
Thyroxine
Triiodothyronine
Methylprednisolone
Propylthiouracil
Thyroxine
Triiodothyronine

Figure

• 

  Fig. 1 The thyroid scintigraphy showed diffuse enlargement with homogenous increased radioiodine uptake of 28%

• 

  Fig. 2 Serial measurements of the thyroid hormone levels and the platelet counts, and treatment dosages of propylthiouracil (PTU) and glucocorticoid during the clinical course

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