A Rare Case Of Graves’ Disease With Splenomegaly And Pancytopenia

  • Elayne Christinne Marcelino e Silva
  • Settings Ricardo Parente Garcia Vieira
  • Maria Misrelma Moura Bessa ABC College of Medicine, Study Design Lab an Scientific
  • Joao Kennedy Teixeira Lima
  • Thyciara Fontenele Marques Faculdade de Medicina Estácio de Juazeiro do Norte


Introduction: Splenomegaly and pancytopenia are rare complications of Graves' disease with few reports in the literature about this association. The pathogenesis is unknown and immunological mechanisms seem to be involved. The possibility of hyperthyroidsm should always considered in patients with pancytopenia.

Objective: Describe  clinical case of association between Grave's disease, splenomegaly and pancytopenia.

Method: This is a case report, obtained through data from medical records of a reference hospital located in the city of Juazeiro do Norte, Ceara, Brazil. Case report: Patient, 46 years old, female, sought treatment at a reference hospital with abdominal pain that started two days earlier, prevalent in mesogastric region and left hypochondrium very intense and recurrent, associated with significant consuptive syndrome ( loss of 10 Kg in 4 months), asthenia, dyspnea on minimum exertion, irritability and fine tremor in extremitie. SHe denied fever, palpitations, heat intolerance, skin ou eye changes. A diffuse thyroid enlargement with the presence of thrill and murmur, digital clubbing, fixed and bright look, light exophthalmos and splenomegaly about 6 cm below the left costal margin were abserved after physical examination. Ultrasound examination (USG) of the abdomen and CT scan showed moderate splenomegaly. Laboratory tests showed normocytic and normochromic anemia, leukocytosis and mild thrombocytopenia. Thyroid USG showed characteristic features of Graves' disease, a bone marrow biopsy revealed maturation preserved in all strains and lack of fibrosis and megakaryocytes present in normal number without atypia. treatment was set with propylthiouracil 300 mg a day and after the first revaluation after hospital discharge three weeks later a regression of splenomegaly has been observed.

Conclusion: This case ilustrates the rare association between hyperthyroidism and splenomegaly with pancytopenia.


Author Biography

Joao Kennedy Teixeira Lima

Universidade Federal De Campina Grande
Faculdade De Medicina Do ABC
Faculdade De Medicina De Juazeiro Do Norte
Centro De Nefrologia De Juazeiro Do Norte
Terapia Renal Do Cariri Ltda


1. Maia AL, Scheffel RS, Meyer ELS, Mazeto GMFS, De Carvalho GA, Graf H, et al. The Brazilian consensus for the diagnosis and treatment of hyperthyroidism: recommendations by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism. Arq Bras Endocrinol Metab 2013; 57(3): 205-232.

2. Jacobson DL. Gange SJ. Rose NR. Graham NM. Epidemiology and estimated population burder of selected autoimune diseases in the United States. Clin Immunol Immunopathol. 1997; 84:.223-243

3. Weetman AP. Graves’ disease. N Engl J Med. 2000; 343: 1236-1248

4. Soeki T, Takamura Y, Kondo N, Shinohara H, Tanaka H, Bando K, et al. A case of thyrotoxicosis with pancitopenia. Endocr J 2001; 48: 385-9.

5. Akasheh MS. Graves' disease mimicking beta-thalassemia trait. Postgrad Med J. 1994 Apr; 70(822): 300–301.

6. Akoum R, Michel S, Wafic T, Emile B, Marwan M, Khaled H, et al. Myelodysplastic syndrome and pancytopenia responding to treatment of hyperthyroidism: peripheral blood and bone marrow analysis before and after antihormonal treatment. Journal of Cancer Research and Therapeutics, 2007; 3(1):43–46.

7. Ahmed MOHS. Atypical clinical manifastations of Grave’s Disease: an analysis in dept. Hindawi Publishing Corporation. Journal of Thyroid Research 2012.

8. Ohtsuka R, Abe Y, Shiratsuchi M, et al. Grave’s disease with splenomegaly and pancytopenia, mimicking B-cell lymphoproliferative disease. Rinsho Ketsueki 2008; 49: 104-108.

9. Low BH, Kok VCK. Hyperthyroidism with Pancytopenia: A Case Report and Literature Review. Formos J Endocrin Metab 2009; 1(1): 23-8.

10. Naji P, Kumar G, Dewani S, Diedrich WA, Gupta A. Grave’s Disease causing pancytopenia and autoimune hemolytic anemia at diferente time intervals: a case report and a review of the literature. Hindawi Publishing Corporation. Case Reports in Medicine 2013.

11. Heng LH, Tan F. Pancytopenia in a patient with Grave’s Disease. Med J Malasia 2013; 68 (4): 372-3.

12. Duquenne M, Lakomsky D, Humbert JC, Hadjadj S, Weryha G, Leclere J. Resolutive pancytopenia with effective treatment of hyperthyroidism. Presse Medicale 1995; 24(17): 807–810.

13. Muroi K 1, Sakuma Y, Izumi T, Sato K, Tanaka Um, Ozawa K. A long course of leukocytopenia and splenomegaly with extramedullary hematopoiesis in the absence of clinically manifested rheumatoid arthritis. J Clin Exp Hematop 2010; 50(2):163-6.

14. Shah A, Diehl LF, St Clair EW. T cell large granular lymphocyte leukemia associated with rhumatoid arthritis and neutropenia. Clin Immunol 2009; 132: 145-152.

15. O’Reilly RA. Splenomegaly in 2505 patients at a large university medical center from 1913 to 1995. WJM 1998; 169(2): 78-87.

16. Kimura M, Amino N, Takada K, Miyai K. Subacute thyroiditis associated with systemic multi-organ disorders. Endocrinol Jpn. 1989 Dec;36(6):859-64.

17. Zaidi ZH. Congenital thyrotoxicosis with hepatoesplenomegaly and trombocytopenia, associated with anidria and deslocated lenses. Proceedings of the Royal Society of Medicine. Section of Pediatrics 1965.

18. Skelton MO, Gans B. Congenital thyrotoxicosis hepatosplenomegaly and jaundice in two infants exoftalmic mothers. Archives of disease in childhood 1955: 460-4.
How to Cite
MARCELINO E SILVA, Elayne Christinne et al. A Rare Case Of Graves’ Disease With Splenomegaly And Pancytopenia. International Archives of Medicine, [S.l.], v. 10, july 2017. ISSN 1755-7682. Available at: <http://imedicalsociety.org/ojs/index.php/iam/article/view/2714>. Date accessed: 19 oct. 2019. doi: https://doi.org/10.3823/2446.