Background: Thyroid abnormalities may be the cause of unexplained pancytopenia. Routine hematologic evaluation should be performed before administration of anti-thyroid drugs in cases of clinical hyperthyroidism, to clarify any occurrence of unexplained pancytopenia.
Case Presentation: An 82-year-old woman presented to the emergency department with general weakness, palpitations, excessive sweating, and weight loss. A complete work-up suggested the existence of hyperthyroidism due to toxic multinodular goiter with depletion of all three cell lines in peripheral blood count. Abdominal ultrasonogram showed no abnormal findings, including hepatosplenomegaly. Normocellular marrow was noted in bone marrow aspiration and biopsy.
Conclusion: A combined drug therapy with methimazole 30 mg/day, parenteral dexamethasone 8 mg/day, beta-blockers, and digoxin was administered to the patient. Free Triiodothyronine (FT3) and Free Thyroxine (FT4) levels decreased gradually and pancytopenia improved within 2 weeks of treatment.
Key words: Goiter, pancytopenia, thyroid disease, case report
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