[Thrombocytopenia in Graves' disease]

We report on a patient with relapse of Graves' disease and immune thrombocytopenia (ITP). In the light of thrombocytopenia, thyroidectomy could not be performed.

Cytologic examinations of the peripheral blood count showed a distinctive thrombocytopenia and giant platelets. In the bone marrow smear, a huge amount of megacaryocytes was seen. Examinations including platelet antibodies, virology studies, helicobacter pylori, and whole body computed tomography showed no pathological results. DIAGNOSIS, TREATMENT UND COURSE: The results were interpreted as ITP. The patient received an intervall of two month several cycles of glucocorticoid treatment and immunglobulines. There was no significant improvement after this therapy. As second-line treatment the patient received rituximab, with no change in the platelet count. In contrast, treatment with a thrombopoietin-receptor-agonist was successful. Finally, normalisation of thyroid function was associated with a normalisation of the platelet count also after discontinuation of ITP treatment.

In recent studies, thrombopoetin-receptor-agonists were established for the treatment of recurrent or refractory ITP. In our case, successful management of Graves' disease including efficient thyreostatic therapy may also have contributed to normalisation of the platelet count. Splenectomy should be deferred in these patients.