Graves’s Disease Case Study
A 56-year-old woman presented to the emergency department with a six-day fever, myalgia, and arthralgia but no concomitant respiratory or gastrointestinal symptoms. Her physical exam was unremarkable, and she was diagnosed with viral fever. Despite her recovery from viral fever, her entire blood count revealed persistent pancytopenia (total white cell count of 2.9 109/L, neutrophil count of 1.1 109/L, hemoglobin of 10.6 g/dL, and platelet count of 110 109/L). The cause of pancytopenia was then investigated. A trephine biopsy and bone marrow aspiration revealed normocellular marrow. Vitamin B12 and folate levels in the blood were normal. Her family history revealed no thyroid disorders.
Further examination revealed that the patient had recently experienced intermittent palpitations, weight loss, and profuse sweating. Following that, the tests ordered proved she had Graves’ disease (free T4 37.8 pmol/L, thyroid stimulating hormone 0.01 mU/L, detection of anti-microsomal and anti-thyroglobulin antibodies). Her hyperthyroidism was treated with 100 mg of propylthiouracil (PTU) twice daily. TSH stands for stimulating thyroid hormone; TWCC stands for total white cell count; Hb stands for hemoglobin; PTU stands for propylthiouracil; CBZ stands for carbimazole; OD stands for once daily; BD stands for twice daily, and TDS stands for three times daily. The patient’s thyroid function test results improved consistently with anti-thyroid therapy, and the resolution of pancytopenia was stable with hyperthyroidism treatment. Her neutrophil count decreased slightly during her follow-up, but this had no clinical significance. According to a clinical review, the patient’s hyperthyroidism symptoms had resolved, but she had gained significant weight.