Generalized Lymphadenopathiesand Pancytopenia in Primary Hypothyroidism
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Abstract
Abstract: Anemia is a very common manifestation in hypothyroidism but pancytopenia withgeneralized lymphadenopathy has rarely been mentioned. Herein we report a 51-year old Thai woman who presents with the generalized purpura, weight loss, progressive enlargement of generalized lymphadenopathies without fever for a few weeks. The physical examination revealed the diffuse enlargement of the thyroid glandand generalized lymphadenopathies 1.5-2 cm. The blood tests show pancytopenia, Hb 8.1 g%, WBC 1,700/mm3, platelet 4,000/mm3, absolute neutrophil count 510/mm3. Other blood tests include TSH >100 uIU/mL, FT3 1.15 pg/dL, FT4 0.2 ng/dL, anti-thyroglobulinand anti-thyroperoxidaseantibodies are positive. The bone marrow biopsy shows normal trilineage with the absence of iron storage whereas the lymph node microscopic pathology is only reactive hyperplasia. Finally she is diagnosed as having primary hypothyroidism due to autoimmune process. After treatment with L-thyroxine 100 mcg a day, without corticosteroid, for a few months, the generalized lymphadenopathy gradually diminishesand the pancytopenia becomes normal. Although the direct association between lymphadenopathy and hypothyroidism cannot be concluded, it may besupposedly related via the autoimmune processes as the basicpathogenesis in common.
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