Abstract #1380427: Graves’ Disease Manifesting as Pancytopenia Without any Other Overt Signs: Case Report

Abstract

Pancytopenia is a rare complication of Graves’ disease although it is usually associated with hematological abnormalities. Here a case of Graves; disease is presented who was admitted with cellulitis and did not have any symptoms of hyperthyroidism on presentation. The patient was found to be pancytopenic, with biochemistry consistent with thyrotoxicosis (TSH < 0.01 mU/L, Free T4 31.7 pmol/L, total T3 6.5 nmol/l). He was seen by hematology team initially and extensive investigations including bone marrow biopsy and CT scan of chest, abdomen and pelvis did not identify the cause of hematological abnormality. His thyroid peroxidase antibody and thyroid receptor antibody were checked which were both positive. After discussion with the endocrine team, he was started on Carbimazole 20mg with close monitoring of his full blood count and thyroid function test. His blood counts continued to improve on Carbimazole and his dose was titrated down to 5mg over next 3 months, with a plan to continue carbimazole for 18 months. Pancytopenia in Graves’ disease is rare and has been described in less than 50 cases in literature. Hematological abnormalities tend to normalize with treatment of thyrotoxicosis in these patients as demonstrated in our case. Evaluation of thyroid status should be considered when evaluating patients with pancytopenia if usual workup does not reveal any cause.