Pancytopenic Thyrotoxicosis: A Management Challenge

Grave’s disease is an autoimmune condition leading to hyperthyroidism whichtypically presents with a combination of hyperthyroid features. It can lead to a numberof haematological alterations and pancytopenia is one such rare complication. Theinitial management of Grave’s primarily resolves around usage of antithyroid drugslike carbimazole. But a common adverse effects of these drugs is marrow suppression.Here we describe a case of Grave’s disease who presented with respiratory tractinfection and had worsening pancytopenia. Extensive workup failed to identify anyexplanation for the pancytopenia other than the thyrotoxic state itself. She could not beinitiated on antithyroid medications initially and was kept on beta blockers andsteroids. GM-CSF analogues like filgastrim and romiplostim were used to bridge thephase of worsening pancytopenia. After resolution of infection and borderline increasein blood counts post therapy with GM-CSF analogues she was started on carbimazolewith subsequent radioiodine ablation. Her pancytopenia improved drastically afterachievement of euthyroid status. In this case report we highlight the managementchallenge posed by worsening pancytopenia in a thyrotoxic patient in the clinicalbackdrop of infection and some therapies which can be used to bridge over thisdifficult situation