Antithyroid treatment improves thrombocytopenia in a young patient with graves' disease

Main Article Content

Maria Felicia Faienza
Viviana Valeria Palmieri
Mariangela Chiarito
Giuseppe Lassandro
Paola Giordano


Thrombocytopenia, Graves’ Disease, antithyroid treatment, immune dysregulation, adolescent


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.



Download data is not yet available.


Metrics Loading ...
Abstract 42 | PDF Downloads 16


1. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM et al. Standardization of terminology, definitions, and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113: 2386-2393. doi: 10.1182/blood-2008-07-162503.
2. Cecinati V, Principi N, Brescia L, Giordano P, Esposito S. Vaccine administration and the development of immune thrombocytopenic purpura in children. Hum Vaccin Immunother. 2013; 9:1158-1162. doi: 10.4161/hv.23601.
3. Del Vecchio GC, Giordano P, Tesse R, Piacente L, Altomare M, De Mattia D. Clinical significance of serum cytokine levels and thrombopoietic markers in childhood idiopathic thrombocytopenic purpura. Blood Transfus. 2012; 10: 194-199. doi: 10.2450/2011.0055-11.
4. Giordano P, Cascioli S, Lassandro G, Marcellini V, Cardinale F, Valente F et al. B-cell hyperfunction in children with immune thrombocytopenic purpura persists after splenectomy. Pediatr Res. 2016; 79: 262-270. doi: 10.1038/pr.2015.211.
5. Zhang F, Chu X, Wang L, Zhu Y, Li L, Ma D, et al. Cell-mediated lysis of autologous platelets in chronic idiopathic thrombocytopenic purpura. Eur J Haematol. 2006; 76: 427-431. doi 10.1111/j.1600-0609.2005.00622.x.
6. Giordano P, Delvecchio M, Lassandro G, Valente F, Palladino V, Chiarito M, et al. Can Anti-Thyroid Antibodies Influence the Outcome of Primary Chronic Immune Thrombocytopenia in Children? Endocr Metab Immune Disord Drug Targets 2019; 19. doi: 10.2174/1871530319666190905161347.
7. Aversa T, Salerno M, Radetti G, Faienza MF, Iughetti L, Corrias A, et al. Peculiarities of presentation and evolution over time of Hashimoto's thyroiditis in children and adolescents with Down's syndrome. Hormones (Athens) 2015; 14: 410-6. doi: 10.14310/horm.2002.1574.
8. Aversa T, Messina MF, Mazzanti L, Salerno M, Mussa A, Faienza MF, et al. The association with Turner syndrome significantly affects the course of Hashimoto's thyroiditis in children, irrespective of karyotype. Endocrine 2015; 50: 777-82. doi: 10.1007/s12020-014-0513-6.
9. Pepe G, Corica D, De Sanctis L, Salerno M, Faienza MF, Tessaris D et al. Prospective evaluation of autoimmune and non-autoimmune subclinical hypothyroidism in Down syndrome children. Eur J Endocrinol 2020; 182: 385-92. Doi: 10.1530/EJE-19-0823
10. Giordano P, Urbano F, Lassandro G, Bianchi FP, Tolva A, Saracco P, et al. Role of antithyroid autoimmunity as a predictive biomarker of chronic immune thrombocytopenia. Pediatr Blood Cancer 2019; 66 : e27452. doi: 10.1002/pbc.27452.
11. Wasniewska M, Corrias A, Arrigo T, Lombardo F, Salerno M, Mussa A, et al. Frequency of Hashimoto’s thyroiditis antecedents in the history of children and adolescents with graves’ disease. Horm Res Paediatr (2010) 73: 473–476. doi: 10.1159/000313395
12. Kurata Y, Nishioeda Y, Tsubakio T, Kitani T. Thrombocytopenia in Graves’ disease: effect of T3 on platelet kinetics. Acta Haematol. 1980; 63: 185-190. doi: 10.1159/000207396.
13. Azar M, Frates A, Rajput V. Idiopathic thrombocytopenic purpura (ITP) and hyperthyroidism: an unusual but critical association for clinicians. J Hosp Med. 2008; 3: 431-3. doi 10.1002/jhm.312.
14. Dogan M, Sal E, Akbayram S, Peker E, Cesur Y, Oner AF. Concurrent celiac disease, idiopathic thrombocytopenic purpura and autoimmune thyroiditis: A case report. Clin Appl Thromb Hemost. 2011; 17:13-16. doi: 10.1177/1076029610378502.
15. Sugimoto K, Sasaki M, Isobe Y, Tamayose K, Hieda M, Oshimi K. Improvement of idiopathic thrombocytopenic purpura by antithyroid therapy. Eur J Haematol. 2005; 74:73-74. doi: 10.1111/j.1600-0609.2004.00341.
16. Gill H, Hwang YY, Tse E. Primary immune thrombocytopenia responding to antithyroid treatment in a patient with Graves’ disease. Ann Hematol. 2011; 90: 223-224. doi: 10.1007/s00277-010-0983-4.
17. Lee AC, Li CH, Wong LM. Childhood thrombocytopenia associated with Graves disease is distinct from idiopathic thrombocytopenic purpura. Pediatr Hematol Oncol. 2003; 20: 39-42.
18. Cheung E, Liebman HA. Thyroid disease in patients with immune thrombocytopenia. Hematol Oncol Clin N Am. 2009;23: 125-1260. doi: 10.1016/j.hoc.2009.08.003.
19. Kohli R, Bleibel W, Bleibel H. Concurrent immune thrombocytopenic purpura and Guillain-Barre syndrome in a patient with Hashimoto’s thyroiditis. Am J Hematol. 2007; 82:307-308. doi: 10.1002/ajh.20771.
20. Ikeda K, Maruyama Y, Yokoyama M, Kato N, Yamanoto H, Kaguchi Y, et al. Association of Graves’ disease with Evans’ syndrome in a patient with IgA nephropathy. Intern Med. 2001; 40:1004-10. doi: 10.2169/internalmedicine.40.1004.
21. Cines DB, Bussel JB, Liebman HA, Luning Prak ET. The ITP syndrome: pathogenic and clinical diversity. Blood 2009; 113:6511-6521. doi: 10.1182/blood-2009-01-129155.
22. Zirilli G, Santucci S, Cuzzupè C, Corica D, Pitrolo E, Salzano G. Peculiarities of autoimmune polyglandular syndromes in children and adolescents. Acta Biomed. 2017; 88:271-275. doi: 10.23750/abm.v88i3.5898.

DB Error: Unknown column 'Array' in 'where clause'