CASE REPORT Idiopathic Thrombocytopenic Purpura (ITP) and Hyperthyroidism: An Unusual But Critical Association for Clinicians Madona Azar 1 Angela Frates 2 Vijay Rajput 3 1 Division of Endocrinology, Diabetes and Metabolism, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma City, OK. 2 Department of Medicine, University of Mary- land, Baltimore, MD. 3 UMDNJ-Robert Wood Johnson Medical School, Cooper University Hospital, Camden, NJ. Journal of Hospital Medicine 2008;3:431–433. V V C 2008 Society of Hospital Medicine. KEYWORDS: thrombocytopenia, autoimmune, ITP, hyperthyroidism, Grave’s. T he connection between idiopathic thrombocytopenic pur- pura (ITP) and Grave’s disease is not well known in the Wes- tern hemisphere. The immunologic relationship between these 2 conditions is well reported 1–5 but poorly defined in the literature. New-onset hyperthyroidism in the setting of preexisting ITP can be overlooked and, if untreated, lead to worsening of the ITP, rendering it refractory to standard therapy. Early recognition and treatment of the hyperthyroid state with antithyroid medications can lead to significant improvement in the platelet count. 1,8 We report this rare but critical clinical relationship. CASE REPORT A 35-year-old Asian woman with a known history of stable ITP for 12 years (baseline platelet count of 40,000/mL) presented to her outpatient provider with a diffuse petechial rash, easy bruisability, and heavy menorrhagia for 2 weeks. Her new platelet count was 7000/mL. She was immediately started on prednisone at a dose of 1 mg/kg without any improvement in her platelet count. At the end of 4 weeks on prednisone, she developed fever, intractable nausea and vomiting, severe headache, hypotension, and tachy- cardia. She was subsequently hospitalized with the presumptive diagnosis of meningitis and sepsis syndrome. Her clinical syn- drome was consistent with systemic inflammatory response syn- drome. She was treated aggressively with intravenous fluids and a broad-spectrum empirical antimicrobial regimen consisting of ceftriaxone, vancomycin, and acyclovir. Lumbar puncture was deferred because of her low platelet count. The sepsis workup, which included viral, fungal, and bacterial blood cultures, remained negative. Her peripheral smear did not show evidence of microangiopathic hemolytic anemia, therefore ruling out thrombotic thrombocytopenic purpura and disseminated intra- vascular coagulation. HIV and tuberculosis were also ruled out. After the initial sepsis workup turned out negative, she was started on solumedrol 125 mg IV every 6 hours. Over the next 2 weeks, she received an average of 4-6 units of platelets per day ª 2008 Society of Hospital Medicine 431 DOI 10.1002/jhm.312 Published online in Wiley InterScience (www.interscience.wiley.com).