In rare instances, cytopenias manifest as a complication of thyrotoxicosis. Here, we report a case of Graves disease (GD) thyrotoxicosis presenting as pancytopenia that resolved with antithyroid therapy.
Case Report PANCYTOPENIA AND LYMPHOID ORGAN HYPERPLASIA IN A PATIENT WITH GRAVES DISEASE: RESPONSE TO ANTITHYROID DRUG THERAPY Jonathan C Li, MD1; Deepika Nandiraju, MD2; Serge Jabbour, MD, FACP, FACE3; Alan A Kubey, MD4,5 ABSTRACT Objective: In rare instances, cytopenias manifest as a complication of thyrotoxicosis Here, we report a case of Graves disease (GD) thyrotoxicosis presenting as pancytopenia that resolved with antithyroid therapy Methods: A 35-year-old male presented with fever and chills following an outpatient colonoscopy Initial blood work revealed pancytopenia Workup included viral antigen titers, blood cultures, rheumatologic antibodies, inflammatory markers, immunocompetency, nutrient deficiency, metal toxicity, and malignancy Bone marrow aspirate was analyzed by microscope, flow cytometry, fluorescence in situ hybridization, and genetic analysis Computed tomography scan of the chest, abdomen, and pelvis was obtained Thyroid labs included thyroid-stimulating hormone, total triiodothyronine, free thyroxine, thyroid-stimulating immunoglobulin, anti-thyroid peroxidase antibody, and radioiodine uptake scan Results: All workup above was non-revelatory except as follows Imaging revealed thymic hyperplasia and splenomegaly Thyroid labs revealed thyroid-stimSubmitted for publication April 17, 2019 Accepted for publication August 16, 2019 From the 1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania and Internal Medicine and Pediatrics Residency Program, Christiana Care Health System, Newark, Delaware, 2Division of Endocrinology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, 3Division of Endocrinology, Diabetes & Metabolic Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, 4Division of Hospital Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, and 5Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota Address correspondence to Dr Jonathan C Li, 1025 Walnut Street #100, Philadelphia, PA 19107 E-mail: Jonathan.C.Li@christianacare.org DOI:10.4158/ACCR-2019-0170 To purchase reprints of this article, please visit: www.aace.com/reprints Copyright â 2019 AACE ulating hormone