Endocrine Abstracts

We would like to report the case of a 45-year-old woman who came to our emergency department two months ago complaining of exhaustion, vomiting, and stomach pain. In the last three weeks, she had three admissions to the ER due to vomiting. She did not have any chronic illnesses, and her only medication for the vomiting was oral electrolytes. In the last two months, she claims to have lost four to five kilograms. The physical examination showed tachycardia (135 beats per minute), hypotension (90/60 mmHg), and subfebrile temperature (37.5 °C). The results of the laboratory test revealed mildly increased bilirubin and transaminases along with pancytopenia. For further testing, she was admitted to the gastrohepatology department. Her minor gastritis following fibrogastroscopy does not account for her vomiting. The following were the outcomes of the laboratory findings in the gastrohepatology report: WBC 2.33×10³/mm³ (4.0-10), RBC 3.4×10⁶/mm³ (3.8-5.20), HGB 9.75 g/dl (12.0-15.0), HCT 28.1% (35-45), MCV 82.56 μm³ (80-87), MCH 28.65 pg (27-32), PLT 95×10³/mm³ (150-440), AST 53 U/l (8-45), ALT 59 U/l (7-55), Total protein 5.1 g/dl (6.6-8.3), Na 136 mmol/l (138-146), K 2.98 mmol/l (3.5-5.5), TSH <0.005 mIU/ml (0.27-4.2), FT4 >100 pg/ml (12-22), FT3 30.44 pmol/l (3.1-30.44), Anti-R-TSH 17 IU/l (<1.5). Ultrasounds of the abdomen and heart were normal. The first courses of treatment included methimazole 5 mg (4 pills daily) and propranolol 40 mg (1 tablet, twice daily). Within a week of the treatment beginning, the symptoms improved. Leucopenia and thrombocytopenia were completely resolved following discharge: RBC 3.5×10⁶/mm³, MCV 88 μm³, MCH 28.8 pg, PLT 177×10³/mm³, WBC 4.7×10³/mm³, HGB 9.9 g/dl, HCT 29.9%. The atypical clinical presentation with vomiting in thyrotoxicosis delayed the diagnosis, resulting in overt hyperthyroidism. Anemia is the most typical symptom of thyroid hormone’s effects on the hematopoietic system, but it can also impact other cell lineages. Pancytopenia, in rare cases, is associated with thyrotoxicosis, and the relationship between thyrotoxicosis and pancytopenia is rarely discussed in the literature; typically, hematologic values are corrected once the treatment is initiated, and the thyrotoxicosis is addressed.