Evans’s Syndrome in Hashimoto’s Thyroiditis: A Case Report

Abstract

Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis which is one of autoimmune diseases may be found associated with other autoimmune diseases but Evans’ syndrome, an autoimmune hemolytic anemia (AIHA) with simultaneous autoimmune thrombocytopenia, has been rarely reported. Herein, we report a 20-year-old Thai woman with Evans’ syndrome who simultaneously develops acute AIHA as well as thrombocytopenia after the diagnosis of Hashimoto’s thyroiditis because of FT₄ 0.1 ng/dl, FT₃ 6.70 pg/ml, TSH > 100 IU/ml, anti-thyroglobulin antibody > 4,000 IU/ml, anti-microsomal antibody > 600 IU/ml has been established and well treated with eltroxin for many years. Her blood tests show pancytopenia: Hb 5.9 g%, WBC 3,400/mm³, platelet 52,000/mm³, reticulocyte 7.2 %, with strongly positive direct antiglobulin test. No other underlying or precipitating diseases are recognized. In other reports of patients with Hashimoto’s thyroiditis, the AIHA always happened few months or years before the occurrence of thrombocytopenia. Our case is additionally diagnosed as Evans’ syndrome and treated with oral prednisolone 60 mg a day and intramuscular injection of vitamin B₁₂ every week. She responds to therapies well, her CBC becomes normal in two months without blood transfusion. The occurrence of Evans’ syndrome in the case of Hashimoto’s thyroiditis may signify their association because both conditions have the autoimmune processes as the main basic pathogenesis with the different target organs, viz., the thyroid gland tissue in Hashimoto’s thyroiditis but the red blood cells, platelets and possibly white blood cells as in our case in Evans’ syndrome.