Co-existence of pancytopenia, autoimmune hemolytic anemia and hepatic dysfunction in intensive care unit patient: Graves’ disease

Mustafa Murat Midik; Şükriye Miray Kılınçer Bozgül; Banu Sarer Yürekli; Devrim Bozkurt

doi:10.19161/etd.1491772

TR EN

Yoğun bakım hastasında pansitopeni, otoimmün hemolitik anemi ve hepatik disfonksiyon birlikteliği: Graves hastalığı

Abstract

Graves hastalığı, nadir de olsa hematolojik bulgular ve hepatik disfonksiyon ile prezente olabilir. Teşhisi zor olabilir ancak tedavide gecikme yaşamamak için erken teşhis önemlidir. Güncel literatür taramalarına göre Graves hastalığında pansitopeni, otoimmün hemolitik anemi (AIHA) ve hepatik disfonksiyonun birlikteliğine daha önce rastlanmamıştır. Kalp yetmezliği semptomları ile yoğun bakım ünitesine başvuran ve pansitopeni, AIHA ve karaciğer fonksiyon testlerinde bozulma ile seyreden ve Graves hastalığı tanısı alan 57 yaşında bir kadın olguyu sunuyoruz. Kortikosteroid, anti-tiroid tedavisi başlandı ve birinci hafta içinde klinik ve laboratuvar bulguları düzeldi. Pansitopeni, AIHA ve hepatik disfonksiyon hastalığın ilk belirtisi olarak ortaya çıkabileceği gibi Graves hastalığı seyrinde de görülebilir. Bu bulguların ortaya çıkması çok nadirdir ve tedaviye iyi yanıt verir.

Keywords

Supporting Institution

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Ethical Statement

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Co-existence of pancytopenia, autoimmune hemolytic anemia and hepatic dysfunction in intensive care unit patient: Graves’ disease

Abstract

Graves' disease (GD) may rarely present with hematologic findings and hepatic dysfunction. Diagnosis may be difficult, but early diagnosis is important to avoid delays in treatment. According to a recent literature review, the association of pancytopenia, autoimmune hemolytic anemia (AIHA) and hepatic dysfunction in GD has not been reported before. We report the case of a 57-year-old woman admitted to the intensive care unit with symptoms of heart failure and diagnosed as GD with pancytopenia, AIHA and impaired liver function tests. Corticosteroid and anti-thyroid treatment was initiated and clinical and laboratory findings improved within the first week. Pancytopenia, AIHA and hepatic dysfunction may occur as the first manifestation of the disease or may be seen in the course of Graves' disease. The occurrence of these severe findings is very rare and respond well to treatment.

Keywords

Supporting Institution

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Ethical Statement

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References

1. Burch, Henry B, and David S Cooper. Management of Graves Disease: A Review. JAMA vol. 314,23 (2015): 2544-54.
2. McLeod DS, Caturegli P, Cooper DS, Matos PG, Hutfless S. Variation in rates of autoimmune thyroid disease by race/ethnicity in US military personnel. JAMA. 2014;311(15):1563-1565.
3. Behera KK, Agrawal K, Adhya AK. Graves' Disease with Pancytopenia and Hepatic Dysfunction: A Rare Case Presentation. Indian J Nucl Med. 2019;34(1):38-41.
4. Lima, C. S., Zantut Wittmann, D. E., Castro, V., Tambascia, M. A., Lorand-Metze, I., Saad, et al. Pancytopenia in untreated patients with Graves' disease. Thyroid : official journal of the American Thyroid Association, 16(4), 403–409.
5. Pincet L, Gorostidi F. Graves Disease Causing Pancytopenia: Case Report and Literature Review. Clin Med Insights Case Rep. 2018;11:1179547618781090.
6. Kandinata SG, Soelistijo SA, Amrita PNA. Graves' Disease Presenting as Autoimmune Hemolytic Anemia. Am J Case Rep. 2021;22:e930705.
7. Hegazi MO, Ahmed S. Atypical clinical manifestations of graves' disease: an analysis in depth. J Thyroid Res. 2012;2012:768019.
8. Meftah N, Sedaghat S, Rabizadeh S, Seifouri S, Nasirimeh K, Nakhjavani M. Graves' disease with pancytopenia:

Details

Primary Language

English

Subjects

Haematology, Endocrinology, Gastroenterology and Hepatology

Journal Section

Case Report

Authors

Mustafa Murat Midik ^*
0000-0001-9529-7772
Türkiye

Şükriye Miray Kılınçer Bozgül
0000-0002-3995-5096
Türkiye

Banu Sarer Yürekli
0000-0003-1809-2655
Türkiye

Devrim Bozkurt
0000-0003-4557-3390
Türkiye

Publication Date

September 3, 2026

Submission Date

May 29, 2024

Acceptance Date

June 18, 2026

Published in Issue

Year 2026 Volume: 65 Number: 3

DOI

https://doi.org/10.19161/etd.1491772

IZ

https://izlik.org/JA72DU99ZF

Cite

RIS / Bibtex

APA

Midik, M. M., Kılınçer Bozgül, Ş. M., Sarer Yürekli, B., & Bozkurt, D. (2026). Co-existence of pancytopenia, autoimmune hemolytic anemia and hepatic dysfunction in intensive care unit patient: Graves’ disease. Ege Tıp Dergisi, 65(3), 620-623. https://doi.org/10.19161/etd.1491772

AMA

1.Midik MM, Kılınçer Bozgül ŞM, Sarer Yürekli B, Bozkurt D. Co-existence of pancytopenia, autoimmune hemolytic anemia and hepatic dysfunction in intensive care unit patient: Graves’ disease. EJM. 2026;65(3):620-623. doi:10.19161/etd.1491772

Chicago

Midik, Mustafa Murat, Şükriye Miray Kılınçer Bozgül, Banu Sarer Yürekli, and Devrim Bozkurt. 2026. “Co-Existence of Pancytopenia, Autoimmune Hemolytic Anemia and Hepatic Dysfunction in Intensive Care Unit Patient: Graves’ Disease”. Ege Tıp Dergisi 65 (3): 620-23. https://doi.org/10.19161/etd.1491772.

EndNote

Midik MM, Kılınçer Bozgül ŞM, Sarer Yürekli B, Bozkurt D (September 1, 2026) Co-existence of pancytopenia, autoimmune hemolytic anemia and hepatic dysfunction in intensive care unit patient: Graves’ disease. Ege Tıp Dergisi 65 3 620–623.

IEEE

[1]M. M. Midik, Ş. M. Kılınçer Bozgül, B. Sarer Yürekli, and D. Bozkurt, “Co-existence of pancytopenia, autoimmune hemolytic anemia and hepatic dysfunction in intensive care unit patient: Graves’ disease”, EJM, vol. 65, no. 3, pp. 620–623, Sept. 2026, doi: 10.19161/etd.1491772.

ISNAD

Midik, Mustafa Murat - Kılınçer Bozgül, Şükriye Miray - Sarer Yürekli, Banu - Bozkurt, Devrim. “Co-Existence of Pancytopenia, Autoimmune Hemolytic Anemia and Hepatic Dysfunction in Intensive Care Unit Patient: Graves’ Disease”. Ege Tıp Dergisi 65/3 (September 1, 2026): 620-623. https://doi.org/10.19161/etd.1491772.

JAMA

1.Midik MM, Kılınçer Bozgül ŞM, Sarer Yürekli B, Bozkurt D. Co-existence of pancytopenia, autoimmune hemolytic anemia and hepatic dysfunction in intensive care unit patient: Graves’ disease. EJM. 2026;65:620–623.

MLA

Midik, Mustafa Murat, et al. “Co-Existence of Pancytopenia, Autoimmune Hemolytic Anemia and Hepatic Dysfunction in Intensive Care Unit Patient: Graves’ Disease”. Ege Tıp Dergisi, vol. 65, no. 3, Sept. 2026, pp. 620-3, doi:10.19161/etd.1491772.

Vancouver

1.Mustafa Murat Midik, Şükriye Miray Kılınçer Bozgül, Banu Sarer Yürekli, Devrim Bozkurt. Co-existence of pancytopenia, autoimmune hemolytic anemia and hepatic dysfunction in intensive care unit patient: Graves’ disease. EJM. 2026 Sep. 1;65(3):620-3. doi:10.19161/etd.1491772