Marta Guilherme Nader, de Campos Fernando Peixoto Ferraz
Internal Medicine Department - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil .
Internal Medicine Department - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
Autops Case Rep. 2015 Jun 30;5(2):45-8. doi: 10.4322/acr.2015.002. eCollection 2015 Apr-Jun.
Immune thrombocytopenia (ITP) is an entity characterized by a platelet count of less than 100 × 10(9)/L in the absence of other causes of thrombocytopenia, such as viral infections, rheumatic diseases, or drugs. Grave's disease is also an autoimmune condition in which thrombocytopenia is often observed. Moreover, in the literature, many reports show a marked interference of the thyroid dysfunction (mainly hyperthyroidism) in the control of thrombocytopenia. Although this issue still remains debatable, the authors report the case of a young woman with a previous diagnosis of ITP with a brilliant initial response to corticotherapy. Some years after this diagnosis, the patient presented thyrotoxicosis due to Grave's disease and the thrombocytopenia relapsed, but this time there was no response to the glucocorticoids. Only after the radioiodine I-131 thyroid ablation the control of thrombocytopenia was achieved. The authors call attention to this overlap and for testing thyroid function in every patient with an unexpected negative response to corticotherapy.
免疫性血小板减少症（ITP）是一种在不存在其他血小板减少原因（如病毒感染、风湿性疾病或药物）的情况下，血小板计数低于100×10⁹/L的病症。格雷夫斯病也是一种常观察到血小板减少的自身免疫性疾病。此外，文献中有许多报道显示甲状腺功能障碍（主要是甲状腺功能亢进）对血小板减少症的控制有显著干扰。尽管这个问题仍有争议，但作者报告了一例先前诊断为ITP的年轻女性病例，该患者对皮质激素治疗最初反应良好。在该诊断后的几年，患者因格雷夫斯病出现甲状腺毒症，血小板减少症复发，但这次对糖皮质激素无反应。仅在进行碘-131甲状腺消融术后，血小板减少症才得到控制。作者提醒注意这种重叠情况，并呼吁对每例对皮质激素治疗意外出现阴性反应的患者进行甲状腺功能检测。
