ESPE Abstracts (2018) 89 P-P3-383

Corticosteroid Resistant Immune Thrombocytopenic Purpura, is it a Marker of Future Graves Disease?

Maria Cristina Azconaa,b, Jose Luis Leona, Monica Pradosa, Amaia Ochotorenaa & Asier Olivera

aClinica Universidad de Navarra, Pamplona, Spain; bIdisna, Pamplona, Spain

Introduction: The Immune Thrombocytopenic Purpura (ITP) and Graves Disease (GD) have in common an autoinmune physiopathology. ITP is characterized by a platelet count less than 100 × 106/l in the absence of other cause. On one hand, ITP has been associated with thyroid dysfunction, without developing GD. On the other hand, GD might develop with moderate thrombocytopenia, generally more than 100×109/l. It is described that in most cases ITP might appear first and then after some years the patient develops hyperthyroidism that points to a GD.

Case Summary: We present the case of a 5-year-old previously healthy female patient who presented petechiae throughout the body without any signs of external bleeding. The peripheral blood count revealed severe thrombocytopenia (3 × 109/l). Other causes of thrombocytopenia were ruled out. Corticosteroid treatment was initiated, and therapeutic response was achieved. Four months after the thrombocytopenia relapsed and corticosteroid treatment was restarted and not effective, therefore Rituximab was indicated. After two years of the initial diagnosis the patient began having distal hand tremors, tachycardia and goiter. An ultrasonography of the thyroid was performed, and it showed a relative enlarged thyroid gland, with high vascularization which can be presented in thyroiditis. Laboratory findings showed suppressed TSH, elevated FT4 levels and positive antithyroid antibodies (TSI and anti-TPO). Methimazole treatment was initiated and euthyroidism was achieved.

Conclusion: Thyroid function should be evaluated if there is any indication of resistance to corticosteroid treatment, since it might be a prediction marker for future thyroid disease.

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