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Acta Biomed. 2020 Nov 20;91(4):e2020194. doi: 10.23750/abm.v91i4.9846.
Autoimmune thyroid disorders, including Graves' disease and Hashimoto's thyroiditis, have been 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). We present the case of a 14-years old girl, who was referred to our Pediatrics Unit, because of contemporary 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 time. A multidisciplinary follow-up has been scheduled, in order to monitor the multi-organ immune dysregulation. This report documents a significant improvement of thrombocytopenia after antithyroid treatment in a young subject affected with Graves' disease.
自身免疫性甲状腺疾病，包括格雷夫斯病和桥本甲状腺炎，已在原发性免疫性血小板减少症（ITP）患者中报告。已经描述了几种将甲状腺疾病与血小板减少联系起来的发病机制。由于甲状腺功能亢进症中血小板寿命缩短、免疫失调和遗传易感性（存在 HLA B8），格雷夫斯病患者中经常记录到血小板减少症。我们报告了一例 14 岁女孩的病例，她因体重减轻、大量出汗和反复鼻出血而被转介到我们的儿科病房。由血液学家和内分泌学家组成的完整医疗团队进行了咨询，以做出诊断。检测到血清 TSH 浓度抑制、抗 TSH 受体抗体存在，同时存在免疫性血小板减少症和阳性抗血小板抗体，此外还检测到直接和间接抗人球蛋白试验阳性而无溶血性贫血、ANA 阳性和 C4 消耗。该患者开始用甲巯咪唑治疗，甲状腺功能和血小板减少症逐渐改善，仅在一次静脉注射免疫球蛋白。已安排多学科随访，以监测多器官免疫失调。本报告记录了在患有格雷夫斯病的年轻患者中，抗甲状腺治疗后血小板减少症显著改善。
