ITP (Idiopathic thrombocytopenic purpura) is a disorder of blood platelets, a circulating fragment of blood cells responsible for ensuring that our blood coagulation system responds appropriately to blood vessel injury by helping blood clots form. When the levels of platelets become abnormally low, or when platelets don't work properly, the risk of bleeding may be increased. Patients with ITP often have circulating antibodies directed against their platelets, in a manner analogous to patients with Graves' disease (GD) that have antibodies directed against their thyroid gland. Both ITP and Graves' disease are autoimmune disorders, and the precise reasons why some immune systems produce these antibodies remains unclear. Nevertheless, patients with GD have a slightly increased risk of developing ITP, and conversely, patients with ITP will have an increased risk of developing autoimmune thyroid disease. There does not seem to be a consistent relationship between progression of ITP and treatment of GD Variable presentation of thrombocytopenia in Graves' disease. Arch Intern Med. 1982 Aug;142(
:1460-4.) although in some instances, treatment of the hyperthyroidism will be associated with improvement in platelet counts. See Graves disease associated with autoimmune thrombocytopenic purpura. Arch Intern Med. 1997 May 12;157(9):1033-6.
www.mythyroid.com/diseaseassociations.html
The literature regarding an association between thyroid disease and immune thrombocytopenic purpura (ITP) suggests that autoimmune thyroid disease is a frequent finding in patients with ITP. A strong association between other systemic autoimmune diseases and autoimmune thyroid diseases is also well documented. Therefore, the combination of autoimmune thyroid disease and ITP could reflect a more significant defect in the immune self-tolerance of these patients compared with those who have primary ITP alone. Such defects may characterize an ITP patient population as more refractory to standard ITP therapy. Screening patients for antithyroid antibodies would identify a patient population at greater risk of developing overt thyroid disease. These patients may be further screened with a thyroid-stimulating hormone assay to detect subclinical thyroid disease.
www.ncbi.nlm.nih.gov/pubmed/19932432
The classic features of excess thyroid hormone (thyrotoxicosis) are nervousness, trouble sleeping, shakiness, rapid heart beat, increased appetite, weight loss (or sometimes weight gain), and increased perspiration. In Graves' disease these symptoms and signs are associated with goiter (enlarged thyroid gland), occasionally with exophthalmos (eyes that protrude from their orbits), and rarely with pretibial myxedema (painless raised nodules on the shins and tops of feet). Obvious physical changes include fine skin and hair, shakiness, rapid pulse, nails that separate from the finger, muscle weakness, fast reflex relaxation, possibly an enlarged spleen, and often fluid retention, especially in the extremities. Patients with Graves' Disease may also have other autoimmune diseases such as pernicious anemia, diabetes, vitiligo (patchy loss of skin pigment), autoimmune ovarian failure, or autoimmunity to platelets (ITP).
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The diagnosis of ITP is based principally on the history, physical examination, complete blood count, and examination of the peripheral smear, which should exclude other causes of thrombocytopenia. Further diagnostic studies (see Table 7) are generally not indicated in the routine work-up of patients with suspected ITP, assuming that the history,
physical examination, and blood counts are compatible with the diagnosis of ITP and do not include atypical findings that are uncommon in ITP or suggest other etiologies. Patients with risk factors for HIV infection should be tested for HIV antibody. Bone marrow aspiration is appropriate to establish the diagnosis in patients over age 60 and in patients considering splenectomy. Additional testing is also generally unnecessary, and sometimes inappropriate, when performed on a routine basis to establish the diagnosis before splenectomy or to evaluate patients who have not responded to glucocorticoid therapy and splenectomy (see Table 7). Preoperative thyroid function testing is appropriate to rule out occult hyperthyroidism or hypothyroidism before elective splenectomy.
bloodjournal.hematologylibrary.org/cgi/reprint/88/1/3.pdf
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