title: Pancytopenia in a surgical patient, a rare presentation of hyperthyroidism.
abstract: BACKGROUND
  Pancytopenia is a rare complication of hyperthyroidism. Various mechanisms have been described such as immunological, bone marrow suppression. The possibility of hyperthyroidism should be considered in patients with unexplained pancytopenia. There are many case reports showing the association between hyperthyroidism and pancytopenia. All of these reports show association between Graves disease and pancytopenia but our case shows association between Multinodular goitre and pancytopenia. Besides it is uncommon to find such association in a surgical patient.
  
  
  METHODS
  This case report describes a 62 yr old hindu female with splenic injury and pancytopenia. On further investigations the patient was found to have hyperthyroidism.
  
  
  CONCLUSIONS
  Though the definite mechanism regarding the association of pancytopenia with hyperthyroidism isn't clear, various cases have been described in the literature. This case shows the diagnostic dilemma that can occur in patients with pancytopenia. Any patient with unexplained pancytopenia should undergo thyroid function tests to rule out hyperthyroidism.
authors.affiliation: Department of Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. prabhatnewton7@yahoo.com.
authors.forename: Prabhat
authors.initials: P
authors.lastname: Jha
authors.forename: Yogendra Prasad
authors.initials: YP
authors.lastname: Singh
authors.forename: Bikal
authors.initials: B
authors.lastname: Ghimire
authors.forename: Binit Kumar
authors.initials: BK
authors.lastname: Jha
mesh_terms: D000058:Accidental Falls; D005260:Female; D006044:Goiter, Nodular / Q000150:complications*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications*; D022125:Lacerations / Q000150:complications* / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D010198:Pancytopenia / Q000209:etiology*; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013158:Splenic Diseases / Q000209:etiology