Imai Ken, Ohkuchi Akihide, Nagayama Shiho, Saito Shinsuke, Matsubara Shigeki, Suzuki Mitsuaki
Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
Division of Endocrinology and Metabolism, Diabetes Center, Department of Medicine, Jichi Medical University, Tochigi, Japan.
J Obstet Gynaecol Res. 2015 Dec;41(12):1991-4. doi: 10.1111/jog.12804. Epub 2015 Aug 26.
Pancytopenia in the first trimester is very rare. A 33-year-old multiparous woman presented with nausea, loss of appetite, and bodyweight loss of 7.4 kg at 9(1/7) weeks of gestation due to hyperemesis gravidarum. Her laboratory data demonstrated pancytopenia involving white blood cell count of 3500/μL, a hemoglobin level of 9.8 g/dL, and a platelet count of 10.5 × 10(4)/μL. An extensive investigation into the causes of the pancytopenia detected true hyperthyroidism: thyroid-stimulating hormone, <0.02 μU/mL; free triiodothyronine, 11.25 pg/mL; free thyroxine, 4.74 ng/dL; and anti-thyroid-stimulating hormone receptor antibodies, 12.2 IU/L. Propylthiouracil was started at a dose of 300 mg/day at 10(5/7) weeks of gestation, which resulted in the normalization of her blood parameters and concomitant improvements in her free triiodothyronine and free thyroxine levels at 12(0/7) weeks of gestation. Pancytopenia in the first trimester might be indicative of hidden hyperthyroidism.
