Clinical association between thyroid disease and immune thrombocytopenia
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ORIGINAL ARTICLE
Clinical association between thyroid disease and immune thrombocytopenia Shoko Ito 1 & Shin-ichiro Fujiwara 1 & Rui Murahashi 1 & Hirotomo Nakashima 1 & Sae Matsuoka 1 & Takashi Ikeda 1 & Shin-ichiro Kawaguchi 1 & Yumiko Toda 1 & Tetsuaki Ban 1 & Takashi Nagayama 1 & Kento Umino 1 & Daisuke Minakata 1 & Kaoru Morita 1 & Hirofumi Nakano 1 & Ryoko Yamasaki 1 & Masahiro Ashizawa 1 & Chihiro Yamamoto 1 & Kaoru Hatano 1 & Kazuya Sato 1 & Iekuni Oh 1 & Ken Ohmine 1 & Yoshinobu Kanda 1 Received: 27 July 2020 / Accepted: 6 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Immune thrombocytopenia (ITP) can coexist with autoimmune thyroid disease. However, the detailed clinical features remain unknown. We retrospectively reviewed 248 patients with newly diagnosed ITP in our institute for whom we had thyroid function data at diagnosis between 2000 and 2019. Of the 248 patients with ITP, 74 patients also had thyroid disease, including 36 with overt thyroid disease (13 Graves’ disease and 23 Hashimoto’s thyroiditis) and 38 with subclinical thyroid disease (3 hyperthyroidism and 35 hypothyroidism). ITP and thyroid disease were concurrently diagnosed in 54 patients. Female sex and positivity for antinuclear antibodies (ANA) were significantly associated with thyroid diseases. Platelet-associated immunoglobulin G (PAIgG) levels in patients with Graves’ disease were higher than those in patients with Hashimoto’s thyroiditis. Platelet counts were similar among euthyroid patients and patients with thyroid disease. Thrombopoietin-receptor agonist was administered more frequently in patients with thyroid disease. The cumulative incidences of thrombosis and bleeding and overall survival did not differ between patients with and without thyroid disease. Treatment for thyroid disease in 22 patients improved thrombocytopenia in 21 patients, especially in 4 patients who were not treated for ITP. This study demonstrated that thyroid diseases were commonly found in patients with ITP. Treatment of the underlying thyroid disease may improve thrombocytopenia. Keywords ITP . Thyroid . Graves’ disease . Hashimoto’s thyroiditis
Introduction Immune thrombocytopenia (ITP) is an autoimmune disease characterized by peripheral platelet destruction and insufficient platelet production [1]. Because of alterations in the immune response and the development of self-reactive antibodies, ITP and other autoimmune diseases, such as antiphospholipid syndrome and systemic lupus erythematosus, can present simultaneously, which is referred to as secondary ITP. The treatment for secondary ITP is treatment of the primary disease. Although it is rare, ITP has also been reported to be associated with autoimmune thyroid disease, hyperthyroidism, and hypothyroidism in several case series
[2–14]. Treatment of thyroid disease has been shown to improve thrombocytopenia, even if ITP was refractory to treatment [15–19]. Patients with ITP often have autoimmune markers including antithyroid antibodies. In a previous study, a
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