title: Pancytopenia in the first trimester: An indicator of hidden hyperthyroidism.
abstract: Pancytopenia in the first trimester is very rare. A 33-year-old multiparous woman presented with nausea, loss of appetite, and bodyweight loss of 7.4 kg at 9(1/7) weeks of gestation due to hyperemesis gravidarum. Her laboratory data demonstrated pancytopenia involving white blood cell count of 3500/μL, a hemoglobin level of 9.8 g/dL, and a platelet count of 10.5 × 10(4)/μL. An extensive investigation into the causes of the pancytopenia detected true hyperthyroidism: thyroid-stimulating hormone, <0.02 μU/mL; free triiodothyronine, 11.25 pg/mL; free thyroxine, 4.74 ng/dL; and anti-thyroid-stimulating hormone receptor antibodies, 12.2 IU/L. Propylthiouracil was started at a dose of 300 mg/day at 10(5/7) weeks of gestation, which resulted in the normalization of her blood parameters and concomitant improvements in her free triiodothyronine and free thyroxine levels at 12(0/7) weeks of gestation. Pancytopenia in the first trimester might be indicative of hidden hyperthyroidism.
authors: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors: Ken
authors: K
authors: Imai
authors: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors: Akihide
authors: A
authors: Ohkuchi
authors: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors: Shiho
authors: S
authors: Nagayama
authors: Division of Endocrinology and Metabolism, Diabetes Center, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors: Shinsuke
authors: S
authors: Saito
authors: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors: Shigeki
authors: S
authors: Matsubara
authors: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors: Mitsuaki
authors: M
authors: Suzuki
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000188:drug therapy; D010198:Pancytopenia / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011261:Pregnancy Trimester, First; D011441:Propylthiouracil / Q000627:therapeutic use
chemical_list: D011441:Propylthiouracil
keywords: first trimester; hyperemesis gravidarum; hyperthyroidism; pancytopenia; pregnancy