SHM Converge Scientific Abstract ePoster Gallery-Graves Disease and Thrombotic Thrombocytopenic Purpura: Causation or Coincidence

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This case report describes a rare concurrent presentation of Graves disease and thrombotic thrombocytopenic purpura (TTP), two autoimmune disorders with unclear causes. A 33-year-old woman initially presented with abdominal pain, nausea, vomiting, night sweats, and dark urine and was treated at an outside hospital for presumed sepsis/SIRS due to UTI. She was transferred after labs showed pancytopenia.<br /><br />Further evaluation revealed microangiopathic hemolytic anemia, hematuria, proteinuria, and low vitamin B12, raising strong suspicion for TTP. ADAMTS13 activity was severely reduced at 3%, confirming the diagnosis. She was immediately started on plasma exchange, high-dose prednisone, and later caplacizumab.<br /><br />Despite appropriate TTP treatment and a negative infectious workup, her SIRS persisted. Review of prior imaging showed incidental thyromegaly months earlier. Repeat CT again showed enlarged thyroid, and thyroid testing confirmed hyperthyroidism with a markedly elevated thyrotropin receptor antibody, establishing Graves disease. After endocrinology started methimazole and a beta blocker, her inflammatory symptoms improved, blood counts recovered, and she was discharged in stable condition.<br /><br />The report emphasizes that TTP is life-threatening and requires rapid diagnosis and treatment. Although Graves disease has only rarely been reported as a trigger for TTP, the association may be clinically meaningful rather than coincidental. Prior case reports suggest that treating hyperthyroidism may help TTP resolve or prevent relapse.<br /><br />The authors conclude that clinicians should consider screening TTP patients for Graves disease and should also evaluate hyperthyroid patients with unexplained thrombocytopenia for possible TTP.

Asset Subtitle

Amritpal S. Pannu

Meta Tag

Author List Amritpal S. Pannu, Ramandeep S. Kaur

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept Microangiopathic Hemolytic Anemia

Concept Thrombocytopenia

Concept ADAMTS13 Deficiency

Concept Total Plasma Exchange

Distinguished Non-Finalist

Presenter Organization Wake Forest University of Health Sciences

Presenting Author Amritpal S. Pannu

Track Adult

Keywords

Graves disease

thrombotic thrombocytopenic purpura

TTP

autoimmune disorders

ADAMTS13 deficiency

plasma exchange

caplacizumab

hyperthyroidism

thrombocytopenia

microangiopathic hemolytic anemia

Thrombotic Thrombocytopenic Purpura

Microangiopathic Hemolytic Anemia

Thrombocytopenia

ADAMTS13 Deficiency

Total Plasma Exchange