Introduction: Untreated hypothyroidism may lead to decompensation of a patients homeostasis. While the association between hypothyroidism and anemia has been noted previously, there are very few, cases of white cell lines and platelet counts being affected by hypothyroidism alone. To demonstrate a rare but significant manifestation of hypothyroidism, we present a unique and interesting case of pancytopenia secondary to severe hypothyroidism
Case report: A70-year-old women, with a past history of diabetes and hypertention for 10 years receiving respectively losartan 50 mg and premixed insulin, patient was admitted for a glycemic imbalance with an HBA1c of 16%, we note a, chronic constipation, progressive weight gain, cold intolerance and drowsiness, there were no signs of adrenal insufficiency. Temperature was 37°C, blood pressure 120/70 mmHg, heart rate 60 beats per minute, with facial myxoedema and normal heart sounds. There was no hepatosplenomegaly. The patients TSH was 92 mIU/l (0.274.2), with total T4 of 1.3 pmol /l (1222).Antithyroid peroxidase antibodies were not detectable. White cell count was 398 000/ml, hemoglobin 11 g/dl, platelet count 98,000/mL, and mean corpuscular volume 82 fL/cell. Blood smear demonstrated absolute neutropenia, thrombocytopenia and normocytic anemia. The cervical ultrasound finds a thyroid gland of heterogeneous hypoechoic echostructure traversed by hyperechoic trabeculae, transthoracic ultrasonography found a left ventricular hypertrophy, ejection fraction preserved at 60% and a dry pericardium. a low dose of levothyrox was started 12.5 μg/day with an increase of 12.5 μg/15J according to clinical and electrocardiographic tolerance, hydrocortisone substitution was started before levothyrox substitution. 4 weeks later, repeated blood counts citrate tube with blood smear and reticulocyte showed resolution of pancytopenia.
Conclusion: We describe a rare complication of severe hypothyroidism, pancytopenia, and its complete reversal after 1 month of thyroid hormone replacement. Mechanisms of this process remain unclear. Interestingly, the lack of detectable antithyroid peroxidase antibodies, like in our case, makes a hematopoietic antigen-antibody reaction a less likely etiology. In cases of unexplained pancytopenia, hypothyroidism should be considered in the differential diagnosis. Further basic studies are needed to determine this underlying disease mechanism.
18 May 2019 - 21 May 2019