Autopsy and Case Reports
Autopsy and Case Reports
Article / Clinical Case Report

Immune thrombocytopenia and autoimmune thyroid disease: a controversial overlap

Guilherme Nader Marta; Fernando Peixoto Ferraz de Campos

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Immune thrombocytopenia (ITP) is an entity characterized by a platelet count of less than 100 × 109/L in the absence of other causes of thrombocytopenia, such as viral infections, rheumatic diseases, or drugs. Grave’s disease is also an autoimmune condition in which thrombocytopenia is often observed. Moreover, in the literature, many reports show a marked interference of the thyroid dysfunction (mainly hyperthyroidism) in the control of thrombocytopenia. Although this issue still remains debatable, the authors report the case of a young woman with a previous diagnosis of ITP with a brilliant initial response to corticotherapy. Some years after this diagnosis, the patient presented thyrotoxicosis due to Grave’s disease and the thrombocytopenia relapsed, but this time there was no response to the glucocorticoids. Only after the radioiodine I-131 thyroid ablation the control of thrombocytopenia was achieved. The authors call attention to this overlap and for testing thyroid function in every patient with an unexpected negative response to corticotherapy.


Hyperthyroidism, Grave’s Disease, Purpura, Thrombocytopenic, Idiopathic, Therapeutics


Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-207. 10.1182/blood-2010-08-302984.21325604

Bromberg ME. Immune thrombocytopenic purpura--the changing therapeutic landscape. N Engl J Med. 2006;355(16):1643-5. 10.1056/NEJMp068169.17050888

Cheung E, Liebman HA. Thyroid disease in patients with immune thrombocytopenia. Hematol Oncol Clin North Am. 2009;23(6):1251-60. 10.1016/j.hoc.2009.08.003.19932432

Brent GA. Clinical practice. Graves’ disease. N Engl J Med. 2008;358(24):2594-605. 10.1056/NEJMcp0801880.18550875

Jackson AS. Acute hemorrhagic purpura associated with exophthalmic goiter. JAMA. 1931;113:2386-93.

Marshall JS, Weisberger AS, Levy RP, Breckenridge RT. Coexistent Idiopathic Thrombocytopenic Purpura and Hyperthyroidism. Ann Intern Med. 1967;67(2):411-4. 10.7326/0003-4819-67-2-411.

Gill H, Hwang YY, Tse E. Primary immune thrombocytopenia responding to antithyroid treatment in a patient with Graves’ disease. Ann Hematol. 2011;90(2):223-4. 10.1007/s00277-010-0983-4.20467745

Pavithran K, Sreekumar A, Krishnamohan VE. Idiopathic thrombocytopenic purpura associated with Graves’ disease--case report. Indian J Med Sci. 1996;50(2):43-6.8979632

Cordiano I, Betterle C, Spadaccino CA, Soini B, Girolami A, Fabris F. Autoimmune thrombocytopenia (AITP) and thyroid autoimmune disease (TAD): overlapping syndromes? Clin Exp Immunol. 1998;113(3):373-8. 10.1046/j.1365-2249.1998.00677.x.9737665

Liebman H. Other immune thrombocytopenias. Semin Hematol. 2007;44(4, Suppl 5):S24-34. 10.1053/j.seminhematol.2007.11.004.18096469

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(1):73-4. 10.1111/j.1600-0609.2004.00341.x.15613111

Kurata Y. NIshioeda Y, Tsubasio T, KitaninT. Thrombocytopenia in Grave’s disease: effect of T3 on platelet kinetics. Acta Hematolol. 1980;63:185-90. 10.1159/000207396.

Hofbauer LC, Spitzweg C, Schmauss S, Heufelder AE. Graves disease associated with autoimmune thrombocytopenic purpura. Arch Intern Med. 1997;157(9):1033-6. 10.1001/archinte.1997.00440300155015.9140276

Bizzaro N. Familial association of autoimmune thrombocytopenia and hyperthyroidism. Am J Hematol. 1992;39(4):294-8. 10.1002/ajh.2830390411.1348160

Grumet FC, Payne RO, Konishi J, Kriss JP. HL-A antigens as markers for disease susceptibility and autoimmunity in Graves’ disease. J Clin Endocrinol Metab. 1974;39(6):1115-9. 10.1210/jcem-39-6-1115.4479624

Vergès B, Giroud-Baleydier F, Olsson O, Vaillant G, Brun JM, Putelat R. [Association of Basedow’s disease and autoimmune thrombopenic purpura. No effect of hyperthyroidism on antiplatelet autoimmunity]. Rev Med Interne. 1989;10(6):565-9.2488511

Cohen Aubart F, Jublanc C, Bruckert E. [Graves’ disease and autoimmune thrombocytopenic purpura: distinct outcomes of the two diseases]. Ann Endocrinol. 2007;68(1):55-7. 10.1016/j.ando.2006.12.001.17292844

Altintas A, Pasa S, Cil T, Bayan K, Gokalp D, Ayyildiz O. Thyroid and celiac diseases autoantibodies in patients with adult chronic idiopathic thrombocytopenic purpura. Platelets. 2008;19(4):252-7. 10.1080/09537100801894651.18569860

Leedman PJ, Faulkner-Jones B, Cram DS, et al. Cloning from the thyroid of a protein related to actin binding protein that is recognized by Graves disease immunoglobulins. Proc Natl Acad Sci USA. 1993;90(13):5994-8. 10.1073/pnas.90.13.5994.8327473

Jung RS, Parghane RV, Sood A, Bhattacharya A, Mittal BR. Primary autoimmune thrombocytopenia and co-existing Graves’ disease: Role of radioiodine-131. Indian J Nucl Med. 2014;29(3):195-6. 10.4103/0972-3919.136602.25210295

Herman J, Resnitzky P, Fink A. Association between thyrotoxicosis and thrombocytopenia. A case report and review of the literature. Isr J Med Sci. 1978;14(4):469-75.566733

Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168-86. 10.1182/blood-2009-06-225565.19846889


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