     Vol 118 No 1220 ISSN 1175 8716 NZMJ 12 August 2005, Vol 118 No 1220 Page 1 of 5 URL: http://www.nzma.org.nz/journal/118-1220/1615/ © NZMA Recovery from pancytopaenia and liver dysfunction after administration of propylthiouracil for Graves’ disease Levent Kebapçılar, Sena Yeil, Fırat Bayraktar, Ali Saklamaz, Tevfik Demir, Özkan Güngör, nci Alacacıolu, Abdurrahman Çömlekçi A case of hyperthyroidism associated with pancytopaenia is described. Hyperthyroidism can be associated with various haematological disorders related to several mechanisms. It should be suggested that the aetiology of pancytopaenia might be due to hyperthyroidism. In the literature to date, pancytopaenia is reported in only five cases of hyperthyroidism. Although the mechanism of pancytopaenia in patients with hyperthyroidism is unclear, it might be related to the reduced lifespan of whole blood components—partially due to the autoimmune mechanism and / or disturbances in maturation and differentiation of the pluripotential stem cells. 1,2 Case report A 53-year-old woman was referred to our hospital complaining of pretibial nonpitting oedema, diarrhoea, and loss of weight during the previous 2 months. The physical examination revealed excessive sweating with sinusal tachycardia (110 beats per minute), associated with high blood pressure, which allowed us to suspect that hyperthyroidism was responsible. The measuring of thyroid functions and autoantibodies confirmed the diagnosis. Thyroid function tests revealed a pattern of primary hyperthyroidism FT3: 7,9 pg/ml (normal: 1.57–4.71), FT4 >6 ng/ml (normal:0.8–1.9), TSH< 0,004 uIU/mL (normal: 0.4–5.0). The antithyroglobulin antibody and antimicrosomal antibody titres were normal, and the TSH receptor antibody (TRAb) titre was 124 U/L (normal range:0–9 U/L). Thyroid function tests showed a pattern of overt primary hyperthyroidism. In thyroid ultrasonography, the thyroid gland diffusely enlarged without nodule. In laboratory findings, the white blood cell count was 3200 uL; significant leucopaenia with a relative neutropaenia (39.5%) and lymphocytosis (48.2%) were present, haemoglobin (Hb) was 9.1 gr/dL, the mean corpuscular volume (MCV) was slightly decreased (78 fL), haematocrit (Hct) was 28.5%, and platelet count 71000 uL. Pancytopaenia was present. Slightly elevated transaminase levels; aspartate aminotransferase(AST) 68 U/L (normal:1–32 U/L), and alanine aminotransferase (ALT) 65 U/L (normal:1-31 U/L) were observed (Figure 1). Haematological examinations showed hypochromic anaemia, leucopaenia, and thrombocytopaenia (Figure 1) with normoplastic bone marrow biopsy. In the laboratory examination, neither haemolytic anaemia nor vitamin B 12 or iron deficiency were observed.