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Case Reports in Medicine
Volume 2013, Article ID 194542, 4 pages
http://dx.doi.org/10.1155/2013/194542
Case Report

Graves’ Disease Causing Pancytopenia and Autoimmune Hemolytic Anemia at Different Time Intervals: A Case Report and a Review of the Literature

1Department of Internal Medicine, Dayton Veterans Affair Medical Center, Boonshoft School of Medicine, Wright State University, 4100 West Third Street, Dayton, OH 45428, USA
2Department of Hematology and Oncology, Dayton Veterans Affair Medical Center, Boonshoft School of Medicine, Wright State University, 4100 West Third Street, Dayton, OH 45428, USA
3Department of Pathology, Dayton Veterans Affair Medical Center, Boonshoft School of Medicine, Wright State University, 4100 West Third Street, Dayton, OH 45428, USA
4Department of Endocrinology and Metabolism, Dayton Veterans Affair Medical Center, Boonshoft School of Medicine, Wright State University, 4100 West Third Street, Dayton, OH 45428, USA

Received 8 July 2013; Accepted 24 September 2013

Academic Editor: Masahiro Kohzuki

Copyright © 2013 Peyman Naji et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Graves’ disease (GD) is associated with various hematologic abnormalities but pancytopenia and autoimmune hemolytic anemia (AIHA) are reported very rarely. Herein, we report a patient with GD who had both of these rare complications at different time intervals, along with a review of the related literature. The patient was a 70-year-old man who, during a hospitalization, was also noted to have pancytopenia and elevated thyroid hormone levels. Complete hematologic workup was unremarkable and his pancytopenia was attributed to hyperthyroidism. He was started on methimazole but unfortunately did not return for followup and stopped methimazole after a few weeks. A year later, he presented with fatigue and weight loss. Labs showed hyperthyroidism and isolated anemia (hemoglobin 7 g/dL). He had positive direct Coombs test and elevated reticulocyte index. He was diagnosed with AIHA and started on glucocorticoids. GD was confirmed with elevated levels of thyroid stimulating immunoglobulins and thyroid uptake and scan. He was treated with methimazole and radioactive iodine ablation. His hemoglobin improved to 10.7 g/dL at discharge without blood transfusion. Graves’ disease should be considered in the differential diagnosis of hematologic abnormalities. These abnormalities in the setting of GD generally respond well to antithyroid treatment.