propylthiouracil and Thrombocytopenia

A 46-year-old woman with Graves' disease was admitted for anemia and thrombocytopenia. She had previously been treated with methimazole but she self-discontinued the treatment 6 months prior to admission. She was diagnosed with Evans syndrome associated with Graves' disease and treated with propylthiouracil without corticosteroids, which normalized her thyroglobulin level. Surprisingly, while Evans syndrome is characterized by frequent relapses, this patient has been in remission of Evans syndrome for approximately 4 years. The remission of Evans syndrome associated with Graves' disease in the absence of immunosuppressive therapy suggests that these 2 diseases have a common pathogenetic mechanism.

Topics: Anemia, Hemolytic, Autoimmune; Female; Graves Disease; Humans; Propylthiouracil; Thrombocytopenia; Treatment Outcome

A male preterm infant (born at 34 weeks, birth weight 2130 g) developed jaundice (total bilirubin 7.4 mg/dl), hepatosplenomegaly, thrombocytopenia (82,000/microliters) and a raised C-reactive protein (1.2 mg/dl). Although sepsis was suspected, no organism was demonstrated. When the mother visited the child for the first time after 2 weeks, she had florid hyperthyroidism. This explained many of the child's clinical features (poor weight gain, tachycardia, exophthalmos). Both mother and child had raised TSH receptor antibodies (mother: 684.6 U/l; 54.1 U/l, normal < 15 U/l), an increased free T4 and a suppressed TSH. Because of the tachycardia, the child was treated with propranolol (1 mg/kg.d for 5 weeks). He was also initially given Lugol's solution (25 mg iodide/kg.d for 1 week) and then propylthiouracil (7 mg/kg.d) because of the increasing total T3. L-Thyroxine replacement was subsequently required for a period of 2.5 weeks because of treatment-related hypothyroidism. Since stopping treatment (at 12 weeks of age), the child has developed normally.--Neonatal hyperthyroidism due to transplacental transfer of TSH receptor antibodies associated with maternal Graves' disease is a rare self-limiting condition. However, it may pose considerable danger to the child both in utero and postnatally (with a mortality if untreated of up to 20%). Interdisciplinary cooperation is essential.

Topics: Adult; Bilirubin; C-Reactive Protein; Drug Therapy, Combination; Female; Graves Disease; Hepatomegaly; Humans; Hyperthyroidism; Infant, Newborn; Iodides; Jaundice, Neonatal; Male; Pregnancy; Pregnancy Complications; Propranolol; Propylthiouracil; Receptors, Thyrotropin; Solutions; Splenomegaly; Thrombocytopenia; Thyroid Hormones; Thyrotropin; Thyroxine

Topics: Adult; Graves Disease; Humans; Methimazole; Propylthiouracil; Thrombocytopenia

Nine of 105 cats with hyperthyroidism treated with propylthiouracil developed a serious immune-mediated drug reaction during treatment. Adverse clinical signs, which developed after 19 to 37 days (mean, 24.8 days) of propylthiouracil administration, included lethargy, weakness, anorexia, and bleeding diathesis. Physical examination revealed pale mucous membranes, and petechial hemorrhages of the skin and oral cavity. Results of hematologic testing revealed severe anemia and thrombocytopenia. The direct antiglobulin (Coombs') test was positive in all 7 cats evaluated, whereas the serum antinuclear antibody titer was greater than or equal to 1:10 in 5 of the 8 cats tested. In 4 of the cats, treatment included appropriate supportive therapy and cessation of propylthiouracil; in these cats, anemia and thrombocytopenia resolved and Coombs' and antinuclear antibody tests became negative within 2 weeks.

Topics: Anemia, Hemolytic; Animals; Antibodies, Antinuclear; Autoimmune Diseases; Cat Diseases; Cats; Female; Hyperthyroidism; Male; Propylthiouracil; Thrombocytopenia

A case of bleeding during operation due to propylthiouracil-induced thrombocytopenia is reported. A 55 year old male who had been treated with propylthiouracil for two months before operation underwent otherwise uneventful cervical laminectomy. Perioperatively he was transfused seven units of whole blood, two units of packed red cells, six units of platelets and two units of fresh frozen plasma for the estimated blood loss of 5500 ml. The patient underwent thyroidectomy without incident 45 days after withdrawal from propylthiouracil. The value of the preoperative coagulation studies of the patient treated with propylthiouracil is discussed.

Topics: Hemorrhage; Humans; Hyperthyroidism; Intraoperative Complications; Male; Middle Aged; Propylthiouracil; Thrombocytopenia

Chronic idiopathic thrombocytopenic purpura (ITP) and hyperthyroidism coexisted in two children. In one, hyperthyroidism developed nine years after the onset of purpura. In the other, the two diseases appeared concomitantly. It is important to distinguish the thrombocytopenia due to ITP from that due to antithyroid drugs.

Topics: Azathioprine; Child; Female; Graves Disease; Humans; Prednisone; Propylthiouracil; Purpura; Purpura, Thrombocytopenic; Splenectomy; Thrombocytopenia