title: Pancytopenia in untreated patients with Graves' disease.
abstract: Severe pancytopenia is a rare but severe complication of thyrotoxicosis. In this report, we describe four patients with Graves' disease who presented with pancytopenia at diagnosis. Methimazole (30-40 mg/d) or propylthiouracil (400 mg/d) restored normal hematopoiesis in three of the patients. The remaining patient evolved to aplastic anemia under therapy with methimazole (60 mg/d), but had an increased peripheral blood count that almost reached normal values after radioiodinetherapy and standard immunosuppressive treatment with antithymocyte globulin (700 mg/d, intravenous infusion for 5 days), oral cyclosporin (400 mg/d), prednisone (30-60 mg/d), and granulocyte colony-stimulating factor (150 microg subcutaneous injection, 3 times per week). We conclude that: (1) a hematologic evaluation of all patients with Graves' disease should be performed before administering antithyroid drugs, (2) antithyroid drugs may be administered to patients with pancytopenia and bone marrow hypercellularity but a reevaluation of the bone marrow must be done if there is no recovery of the peripheral blood cell count when euthyroidism state is achieved, (3) standard immunosuppressive treatment of aplastic anemia caused by antithyroid drugs restores normal hematopoiesis, and (4) a thyroid evaluation of patients with pancytopenia should be done, even though no related symptoms are found.
authors.affiliation: Hematology and Hemotherapy, Department of Internal Medicine, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Carmen S P
authors.initials: CS
authors.lastname: Lima
authors.forename: Denise E
authors.initials: DE
authors.lastname: Zantut Wittmann
authors.forename: Vagner
authors.initials: V
authors.lastname: Castro
authors.forename: Marcos A
authors.initials: MA
authors.lastname: Tambascia
authors.forename: Irene
authors.initials: I
authors.lastname: Lorand-Metze
authors.forename: Sara T O
authors.initials: ST
authors.lastname: Saad
authors.forename: Fernando F
authors.initials: FF
authors.lastname: Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008713:Methimazole / Q000627:therapeutic use; D010198:Pancytopenia / Q000188:drug therapy / Q000209:etiology*
chemical_list: D008713:Methimazole