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Clinical association between thyroid disease and immune thrombocytopenia

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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.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Shoko Ito, Shin-ichiro Fujiwara, Rui Murahashi, Hirotomo Nakashima, Sae Matsuoka, Takashi Ikeda, Shin-ichiro Kawaguchi, Yumiko Toda, Tetsuaki Ban, Takashi Nagayama, Kento Umino, Daisuke Minakata, Kaoru Morita, Hirofumi Nakano, Ryoko Yamasaki, Masahiro Ashizawa, Chihiro Yamamoto, Kaoru Hatano, Kazuya Sato, Iekuni Oh, Ken Ohmine & Yoshinobu Kanda

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Contributions

SI performed the research and collected and analyzed the data. SI, SF, and YK analyzed the data and wrote the paper. All the authors wrote the paper and approved the final version.

Corresponding author

Correspondence to Yoshinobu Kanda.

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The authors declare that they have no conflict of interest.

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For this retrospective study, formal informed consent is not required. This study was approved by the Institutional Review Board of Jichi Medical University and performed in accordance with the Declaration of Helsinki and its later amendments.

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ESM 4

Chronic ITP was diagnosed in a 29-year-old woman. After 6 months, she was incidentally diagnosed with Hashimoto’s thyroiditis at another hospital. She was administrated levothyroxine. Several months later, her platelet count increased to 140 × 109/l without treatment of ITP. (PPT 156 kb).

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Ito, S., Fujiwara, Si., Murahashi, R. et al. Clinical association between thyroid disease and immune thrombocytopenia. Ann Hematol 100, 345–352 (2021). https://doi.org/10.1007/s00277-020-04343-5

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