Department of Internal Medicine, Greater Accra Regional Hospital (Ridge Hospital), Ridge, P. O. Box GP 473, Accra, Ghana.
School of Medicine, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana.
J Med Case Rep. 2023 Apr 5;17(1):122. doi: 10.1186/s13256-023-03869-2.
Immune thrombocytopenic purpura is a condition associated with an unusual, unexplained, and sometimes very severe reduction in the level of platelets in the blood. Though documented, its association with Graves' disease is not very common and can easily be missed or misdiagnosed, leading to excessive bleeding and mortality. Treatment with steroids and antithyroid medications has been shown to be beneficial in correcting thrombocytopenia in these patients, although the response is varied. We report on a patient with Graves' disease who presents with immune thrombocytopenic purpura.
A 37-year-old Ghanaian female presented to our hospital's emergency department with a complaint of palpitations, difficulty breathing, easy fatigue, and headaches. She had been referred from a peripheral hospital as a case of thrombocytopenia, severe anemia, and anterior neck swelling. She was diagnosed with Graves' disease 2 years ago, became euthyroid during treatment, but defaulted. On further examination and investigation, she was diagnosed with immune thrombocytopenic purpura and was also found to have elevated free T3 and T4, and suppressed thyroid stimulating hormone. She also had high thyroid autoantibodies. She was initially started on oral prednisolone but there was no stabilization of platelets until methimazole was introduced, which improved and normalized her platelet count.
The association of Graves' disease with immune thrombocytopenic purpura, though documented, is uncommon, and very few cases have been reported thus far. There have not been any reported cases in Ghana or Sub-Saharan Africa and hence, clinicians should be aware of this association when investigating immune thrombocytopenic purpura and should consider Graves' disease as a possible cause. From this study, we observed that there was no improvement in platelet count following the use of corticosteroid therapy until methimazole was started.
免疫性血小板减少性紫癜是一种与血小板在血液中水平异常、不明原因且有时非常严重下降相关的病症。尽管已有相关记录，但它与格雷夫斯病的关联并不常见，很容易被忽视或误诊，导致过度出血和死亡。用类固醇和抗甲状腺药物治疗已被证明可有效纠正这些患者的血小板减少症，尽管反应各不相同。我们报告了一例患有格雷夫斯病的患者，该患者出现免疫性血小板减少性紫癜。
一名 37 岁加纳女性因心悸、呼吸困难、易疲劳和头痛到我们医院急诊就诊。她之前在一家外围医院被诊断为血小板减少症、严重贫血和前颈部肿胀，并被转诊至我院。她在 2 年前被诊断患有格雷夫斯病，在治疗期间甲状腺功能正常，但后来失访。进一步的检查和调查发现她患有免疫性血小板减少性紫癜，并且还发现游离 T3 和 T4 升高，促甲状腺激素受抑制。她还具有较高的甲状腺自身抗体。她最初接受了口服泼尼松龙治疗，但血小板没有稳定，直到引入甲巯咪唑后才得到改善和正常化。
尽管已有相关记录，但格雷夫斯病与免疫性血小板减少性紫癜的关联并不常见，到目前为止报告的病例很少。加纳或撒哈拉以南非洲没有报告过此类病例，因此临床医生在调查免疫性血小板减少性紫癜时应意识到这种关联，并应考虑格雷夫斯病作为可能的病因。从这项研究中，我们观察到在开始使用甲巯咪唑之前，使用皮质类固醇治疗并没有改善血小板计数。
