Pancytopenia in a Patient With Severe Hypothyroidism: A Case Report

Abstract Introduction: Hypothyroidism usually affects red blood cell line most commonly seen as normochromic normocytic anemia. We present a unique case of patient with pancytopenia in the setting severe hypothyroidism, which improved following IV thyroid hormone replacement. Case: An 85-year-old female history type II diabetes mellitus and hypothyroidism who was admitted for open reduction internal fixation (ORIF) displaced left femur fracture mechanical fall. Patient has long-standing on replacement levothyroxine 75 mcg, inadvertently discontinued at nursing home 2 weeks prior to presentation. CBC admission notable macrocytic anemia hemoglobin 6.2 g/dl (baseline 11), leukopenia WBC 4.2 x103/ul thrombocytopenia platelet 77 X 103 /ul. TSH 83 uIU/mL (reference range: 0.34 - 5.6) Free T4 < 0.11 ng/dl 0.93 1.7). verge developing myxedema coma she presented hypotension pressure 103/55 mmHg, hyponatremia 133 mmol/L mild change mental status. There no evidence hypothermia or bradycardia. Presence small thigh hematoma examination partially explained acute drop hemoglobin. Iron panel, folic acid vitamin B12 levels were found be within normal range. had active infection suggest sepsis did not receive any myelosuppressive medication. Rapid started before proceeding surgery prevent development coma. normalized 1.05 after receiving total 700 mcg day 5 hospitalization. ORIF done complications. Pancytopenia resolved upon therapy discharged her regular dose daily. Discussion: Most common hematologic abnormality associated is Currently, there are less than 10 reported cases hypothyroidism. The exact mechanism unclear but proposed hypothesis transient bone marrow hypoplasia. clinical presentation, our patient, profound ultimate outcome these patients resolution adequate Interestingly, all have been population. Further research needed understand pathophysiology, risk factors, prognosis recurrence More importantly, must certainly entertained differential diagnosis pancytopenia.