Background: Autoimmune thyroid disorders, including Graves’ disease and Hashimoto’s thyroiditis, were reported in patients with primary immune thrombocytopenia (ITP).
Several etiopathogenetic mechanisms connecting thyroid diseases and thrombocytopenia have been described. Thrombocytopenia is often documented in patients with Graves’ disease, due to reduced platelet life span in hyperthyroidism, immune dysregulation and genetic predisposition (HLA B8 presence). Thyroid autoantibodies have been detected in 89% of patients with ITP and autoimmune thyroid disease.

Aims: Our report broadens the knowledge about the clinical and therapeutic management of patients suffering from ITP and Graves’ disease

Methods: We present the case of a 14-years old girl, who was referred to our Pediatrics Unit, because of the appearance of weight loss, profuse sweating and episodes of recurrent epistaxis. A complete health team, made up of hematologists and endocrinologists, met in consultation in order to reach a diagnosis. A suppression of serum TSH concentrations, the presence of anti-TSH receptor antibodies and at the same time an immune thrombocytopenia with positive anti-platelet antibodies, have been detected. Furthermore, a positive direct and indirect Coombs test without hemolytic anemia, ANA positivity, and a C4 consumption have been documented. The patient started treatment with thiamazole with progressive improvement of thyroid function and thrombocytopenia, requiring only an intravenous immunoglobulin infusion on one occasion. A multidisciplinary follow-up has been scheduled, in order to monitor the multi-organ immune dysregulation.

Results: This is the first report that documents a significant improvement in thrombocytopenia, following the administration of antithyroid treatment alone in a young subject suffering from Graves´ disease.

Conclusions: In literature, reports of ITP responding to antithyroid treatment in patients with Graves’ disease have been reported, but the peculiarity of our case is that platelet count recovery has been obtained with only antithyroid treatment, without further specific therapies for ITP, if not on one occasion the administration of intravenous immunoglobulin.

[Platelet count recovery after start of antithyroid treatment]

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/antithyroid-treatment-improves-thrombocytopenia-in-a-young-patient-with-graves-disease-a-case-report/