Immune thrombocytopenia associated with Hashimoto thyroiditis in a pediatric patient: A case report.
Immune thrombocytopenia associated with Hashimoto thyroiditis in a pediatric patient: A case report.
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DOI：
10.1097/md.0000000000026140
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发表时间：
2021-06-04
期刊：
影响因子：
1.6
通讯作者：
Li X
中科院分区：
文献类型：
--
作者：
Tian Z;Gao H;Xiao D;Li X
免疫性血小板减少症（ITP）是儿童最常见的获得性出血性疾病之一。感染和自身免疫性疾病是ITP最常见的原因。ITP的发病机制复杂，尚未完全了解。了解ITP的潜在原因或障碍将改善预后，使治疗更有针对性。一名8岁的ITP女孩对一线和二线治疗反应不佳。患者皮肤多处散在点、瘀斑、紫癜及口腔黏膜血凝块。诊断为ITP合并桥本甲状腺炎。患者入住急诊科，接受血小板输注、静脉注射、糖皮质激素和电子波包治疗。患者的血小板减少在给予左甲状腺素治疗后18天内消失。诊断为桥本甲状腺炎，左旋甲状腺素治疗第3天血小板计数恢复。随访2个月，左旋甲状腺素和强的松治疗后血小板计数稳定正常。早期发现潜在的原因并采用多种方式治疗可能有助于改善ITP的预后。甲状腺疾病的治疗和甲状腺正常状态的恢复影响儿童ITP的临床预后。
Immune thrombocytopenia (ITP) is one of the most commonly acquired bleeding diseases in children. Infection and autoimmune disorders are the most common causes of ITP. The pathogenic mechanism of ITP is complex and is not completely understood. Understanding the underlying causes or disorders of ITP will improve the prognosis and make therapy more targeted. An 8-year-old girl with ITP responded poorly to first- and second-line treatment. The patient showed multiple scattered petechiae, ecchymoses, and purpura in the skin and blood clots in the oral mucous membrane. The patient was diagnosed with ITP associated with Hashimoto thyroiditis. The patient was admitted to our emergency department and received platelet transfusion, IVIG, glucocorticoids and eltrombopag. The patient's thrombocytopenia resolved within 18 days after the administration of levothyroxine treatment. The patient was diagnosed with Hashimoto thyroiditis, and the platelet count recovered on the 3rd day of levothyroxine treatment. The platelet count became steadily normal with levothyroxine and prednisone treatment within 2 months of follow-up. Early identification of the underlying reasons and treatment with multiple modalities may be useful in improving the prognosis of ITP. The treatment of thyroid disease and restoration of the euthyroid state impact the clinical outcome of ITP in children.