Pancytopenia in a Patient with Graves' Disease

Graves' disease is implicated if correction of the Graves' disease resolves the pancytopenia.

Possible causes:

(1) autoimmune disease targeting bone marrow elements

(2) autoimmune disease targeting vitamin B12 (pernicious anemia, other)

(3) drugs used to treat the Graves' disease, including radioactive iodine

(4) hypersplenism or other organ sequestration

(5) other condition independent of Graves disease

The timing of antithyroid drugs is important. If the pancytopenia improves with drug therapy, then another cause should be considered. If the pancytopenia appears after start of drug therapy, then drug therapy should be considered.

A patient with unexplained pancytopenia should be screened for Graves' disease as part of the workup.