ACTA ENDOCRINOLOGICA (BUC)

It is known that antithyroid drugs have been associated with development of agranulocytosis or secondary autoimmune neutropenia. Aplastic anemia is an unusual but severe form of haematological complication after antithyroid drugs. We are presenting a case of a 34-year old woman diagnosed with Graves’ disease, based on ophthalmopathy, symptoms and signs of hyperthyroidism, a diffuse enlargement of the thyroid gland; TSH level= 0.17 mU/L, fT4= 28 pmol/L, T3= 4.92 nmol/L, thyroglobulin antibodies= 117 IU/mL. The patient developed, after six weeks of treatment with Carbimazole 60 mg daily, a moderate aplastic anemia (pancytopenia: haemoglobin level= 8.2 g/dL, granulocytes= 800/mmc, platelets= 40,000/mmc; hypocellular bone marrow with increased fat cells and lymphocytosis, plasmocytosis and mastocytosis, in the absence of neoplastic or infectious infiltrations, possibly with immune aetiology suggested by disturbance of CD4/CD8 and favourable response after immunosuppressive therapy). Therapy was represented by: stopping the administration of carbimazole, broad spectrum antibiotics, antiviral and antifungal prophylaxis,general and dental hygiene, high doses of methylprednisolone followed by Cyclosporin A 12 mg/kg/day, with favourable evolution. The serum T3 and T3/T4 ratio increased after the antithyroid drug regimen was stopped . After 3 months of therapy, the patient was in complete haematological response with haemoglobin value= 11.8g/dL, granulocytes= 2.200/mmc, platelets = 130,000/mmc and was submitted to subtotal thyroidectomy.