Pincet Laurence, Gorostidi François
ENT Surgery Department, University Hospital Centre (CHUV), Lausanne, Switzerland.
Clin Med Insights Case Rep. 2018 Jun 25;11:1179547618781090. doi: 10.1177/1179547618781090. eCollection 2018.
Graves disease or other causes of thyrotoxicosis are frequently associated with cytopenia. Although anemia is the most common, other cell lineage can be affected. Pancytopenia is a rare complication of thyrotoxicosis.
We report a case of a 33-year-old Chinese man who presented a nonsevere pancytopenia in the context of a newly diagnosed Graves disease. Restauration of euthyroid state led to progressive correction of pancytopenia.
Literature review shows other rare cases of pancytopenia. It is usually nonsevere with just extremely rare cases of transfusion reported. Evolution was always favorable after achievement of euthyroid state. Its mechanism remains poorly understood, especially because those patients have no vitamin or iron deficiency. The exact physiopathological process remains unclear but 2 causes seem to overlap: reduced production of hematopoietic cells from the bone marrow and increased destruction or sequestration of mature hematopoietic cells. Despite unclear mechanism, the presence of hematologic abnormalities including pancytopenia must not be considered as a contraindication to antithyroid drug therapy.
格雷夫斯病或其他甲状腺毒症病因常与血细胞减少相关。虽然贫血最为常见，但其他细胞系也可能受到影响。全血细胞减少是甲状腺毒症的一种罕见并发症。
我们报告一例33岁中国男性病例，该患者在新诊断的格雷夫斯病背景下出现非重度全血细胞减少。甲状腺功能恢复正常后，全血细胞减少逐渐得到纠正。
文献回顾显示还有其他全血细胞减少的罕见病例。通常病情不严重，仅有极罕见的输血病例报道。甲状腺功能恢复正常后病情总是向好发展。其机制仍知之甚少，尤其是因为这些患者没有维生素或铁缺乏。确切的病理生理过程尚不清楚，但似乎有两个原因相互重叠：骨髓造血细胞生成减少以及成熟造血细胞破坏或滞留增加。尽管机制不明，但包括全血细胞减少在内的血液学异常的存在不应被视为抗甲状腺药物治疗的禁忌证。
