Thrombotic Thrombocytopenic Purpura with Hashimoto Thyroiditis: A case Report

Abstract

       Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis) and thrombotic thrombocytopenic purpura (TTP) similarly have an autoimmune process as the basic pathogenesis. A case of 89-year-old Thai woman is found to have the history of sudden onset of left hemiparesis as the transient ischemic attack just few hours before admission, microangiopathic hemolytic anemia, thrombocytopenia with multiple purpura, high serum LDH, and mild renal impairment, the classical pentad of TTP, with the severe deficiency of plasma ADAMTS 13 factor activity. The computerized tomography of the brain does not show any intracerebral hemorrhage, just only multiple lacunar infarcts. Her underlying disease is long term well controlled Hashimoto’s thyroiditis and hypertension. She responds well to the repeated plasma exchange transfusion and oral corticosteroid. Her clinical and all laboratory manifestations become normal within one month. The occurrence of TTP in case of Hashimoto’s thyroiditis may signify their association as the autoimmune diseases but different autoantibodies with different targets, anti-thyroglobulin and anti-thyroperoxidase with thyroid cell destruction in Hashimoto’s thyroiditis and anti-ADAMTS13 factor leading to ADAMTS13 factor deficiency in TTP.