The effect of anti-thyroid antibodies positivity on children with primary immune thrombocytopenia

Immune thrombocytopenia associated with Hashimoto thyroiditis in a pediatric patient: A case report

RATIONALE

Immune thrombocytopenia (ITP) is one of the most commonly acquired bleeding diseases in children. Infection and autoimmune disorders are the most common causes of ITP. The pathogenic mechanism of ITP is complex and is not completely understood. Understanding the underlying causes or disorders of ITP will improve the prognosis and make therapy more targeted.

PATIENT CONCERNS

An 8-year-old girl with ITP responded poorly to first- and second-line treatment. The patient showed multiple scattered petechiae, ecchymoses, and purpura in the skin and blood clots in the oral mucous membrane.

DIAGNOSES

The patient was diagnosed with ITP associated with Hashimoto thyroiditis.

INTERVENTIONS

The patient was admitted to our emergency department and received platelet transfusion, IVIG, glucocorticoids and eltrombopag. The patient's thrombocytopenia resolved within 18 days after the administration of levothyroxine treatment.

OUTCOMES

The patient was diagnosed with Hashimoto thyroiditis, and the platelet count recovered on the 3rd day of levothyroxine treatment. The platelet count became steadily normal with levothyroxine and prednisone treatment within 2 months of follow-up.

LESSONS

Early identification of the underlying reasons and treatment with multiple modalities may be useful in improving the prognosis of ITP. The treatment of thyroid disease and restoration of the euthyroid state impact the clinical outcome of ITP in children.

Chronic Immune Thrombocytopenia and Hashimoto's Hypothyroidism in an Adolescent: Presentation and Implications

Immune thrombocytopenia (ITP) is a disorder characterized by immune-mediated destruction of thrombocytes leading to peripheral blood platelet count of <100 × 10^9/L. Primary ITP is a terminology used in the absence of other causes or disorders that may be associated with thrombocytopenia, i.e., isolated thrombocytopenia. The term secondary ITP is used if such diseases coexist. We present here a case of a 14-year-old female diagnosed with immune thrombocytopenia. When her evaluation was not strongly supportive of primary ITP, she was screened and proved to have a concomitant Hashimoto thyroiditis. Contrary to the popular belief about secondary ITP in adult population, treatment of our patient's hypothyroidism did not improve her platelet's count, and the patient needed multiple immunosuppressive medications to improve her condition.

Can Anti-Thyroid Antibodies Influence the Outcome of Primary Chronic Immune Thrombocytopenia in Children?

Background:

Immune thrombocytopenia (ITP) is an acquired immune mediated disorder characterized by isolated thrombocytopenia. Pediatric ITP patients can develop autoantibodies such as anti-thyroglobulin (TG) and anti-thyroperoxidase (TPO), even in the absence of clinical signs of autoimmune disease.

Objective:

The purpose of this article is to provide a review about: 1) the prevalence of positivity of anti-thyroid antibodies (TPO and TG) in pediatric patients with chronic ITP; 2) the role of autoimmune thyroiditis on the outcome of chronic ITP.

Method:

The authors individually completed a review of the literature for this article. Retrospective and prospective clinical studies with pediatric cohorts were considered.

Results:

From the analysis of data, we found 4 papers which included studies only on pediatric population, and which corresponded to selected criteria. Pediatric ITP patients have been shown to have a statistically significant prevalence of anti-thyroid antibodies over healthy controls (11.6-36% versus 1.2-1.3%). No correlation has been found between the platelet count and the prevalence of positive anti-thyroid antibodies at any time of the follow up.

Conclusion:

The results of our bibliographic research demonstrated that: a) pediatric patients with chronic ITP tend to have a statistically significant prevalence of anti-thyroid antibodies positivity respect to general pediatric population; b) there are no clear data about the role of autoimmune thyroiditis as prognostic factor for chronic course of ITP in pediatric age.

Thrombocytopaenia and thyroiditis: coincidence?

Thrombocytopaenia can be associated with an autoimmune mechanism. Immune thrombocytopaenia can be associated with thyroid autoimmune disease. The authors present a case of a teenager with a history of thrombocytopaenia who complained of tiredness. Laboratory investigation showed thyroid autoantibodies. The co-existence of thrombocytopaenia and thyroiditis lead to further investigation and antibodies against platelet glycoprotein IIbIIIa were found. This case illustrates the association of the overlap aspects between thyroid and platelet autoimmunity.