(7.03) A Rare Coexistence: Grave’s Disease Masked by Immune Thrombocytopenic Purpura

       _{Immune thrombocytopenic purpura is characterized by an unexplained reduction in platelet count and is infrequently linked with autoimmune diseases, particularly Grave's disease. This rare association can lead to diagnostic challenges, with Grave's disease often remaining undetected in patients presenting with ITP. Addressing the underlying Grave's disease in patients with ITP can result in an improvement in thrombocytopenia. We report on a patient with undiagnosed Grave’s disease, which was discovered when she presented with immune thrombocytopenic purpura.}

 

Case(s) Description : ^{A 25-year-old female with no significant medical history presented with heavy vaginal bleeding and epistaxis. She was referred to the Emergency Department due to a critically low platelet count of 8,000/uL. Upon examination, she was tachycardic (115 bpm), with flushed skin and an erythematous rash on her thigh. Thyroid function tests showed suppressed TSH (< 0.05 uIU/mL), elevated free T4 (2.7 ng/dL), and elevated total T3 (3 ng/mL). Two months prior in the outpatient setting, TSH was normal (2.010 uIU/mL), but rechecked four weeks later, it was < 0.010 uIU/mL. Further investigation in this hospital admission revealed elevated thyroid stimulating immunoglobulin levels (TSI) at 488, and elevated thyroid peroxidase antibodies at 1263 IU/mL, confirming autoimmune thyroid disease. Initially treated with high-dose steroids for suspected immune thrombocytopenia (ITP), the diagnosis had now shifted toward a thyroid disorder. Transfusion of one dose of platelet concentrate was done, which minimally improved her platelet count. Our team added methimazole and a low-dose beta-blocker to treat her overt hyperthyroidism. This intervention normalized her free T4 level within four days and improved her platelet count significantly to 48,000/uL.}

Discussion :

       ^{We present a case of a patient who presented with ITP, which revealed to be connected to undiagnosed Grave's disease, thereby demonstrating the profound impact of a comprehensive diagnostic evaluation in autoimmune disorders. The rare coexistence of Grave's disease with immune thrombocytopenia (ITP) highlights a key clinical insight. This combination suggests a more profound immune self-tolerance defect, possibly reducing the efficacy of standard ITP treatments. Treating the underlying thyroid disorder in these cases often leads to ITP remission, emphasizing the necessity of performing thyroid function tests in ITP patients. Screening for antithyroid antibodies in ITP cases may also be recommended to identify those at an increased risk of developing thyroid disease. Clinicians should be aware of this association in ITP management, as concurrent Grave's disease may require a specialized treatment strategy.}