coexistence of hyperthyroidism and primary immune thrombocytopenia ( itp ) is a rather rare condition .
underlying untreated graves disease leads to worsening of the itp and rendering it refractory to standard therapy .
a 71-year - old female patient presented with a complaint of excessive sweating for nearly a month to a hematology unit where she had been followed - up with after a diagnosis of itp .
her laboratory tests revealed manifest hyperthyroidism in addition to thrombocytopenia , and hence she was referred to our endocrinology unit . on her physical examination , her pulse rate was 112 bpm , and her skin was warm and damp .
increased levels of anti - thyroid peroxidase , anti - thyroglobulin , and thyroid - stimulating antibody and enhanced uptake of radioactive iodine were observed , and the diagnosis of graves disease was confirmed .
methimazole therapy at daily doses of 30 mg was initiated . without any additional immunosuppressive treatment , at week 12 of methimazole therapy
, thyroid stimulating hormone ( tsh ) levels returned to normal , and platelet counts rose to tolerable levels .
when her hospital records were analyzed , they revealed that a year ago , when she had been diagnosed with itp , her tsh values had been suppressed . at that time
she had been given intravenous immune globulin ( 0.5 g / kg / day for 4 days ) and oral steroid ( 1 mg / kg / day ) for the treatment of itp .
the patient , whose platelet counts returned to being within normal limits , was followed - up with for 6 months . during this period ,
her platelet values were maintained at normal levels , and during her control visits , her tsh levels were measured twice and were within normal limits .
the patient 's laboratory test results are shown in chronological order [ table 1 ] .
afterwards , concomitancy of autoimmune thyroid diseases such as hashimoto thyroiditis and graves disease with itp has been reported many times . in graves disease ,
the lifespan of platelets is shortened significantly , and moderate degrees of thrombocytopenia are frequently seen . the potential mechanism involved in this process
the association between itp and graves disease is explained by immune dysregulation , which is the main mechanism underlying both diseases and involves an increase in the levels of antiplatelet and anti - thyroid antibodies in these patients . because of the strong fundamental autoimmune mechanism underlying both diseases , it is known that the treatment of associated autoimmune thyroid disorder contributes to the remission of itp .
it has been reported that the treatment of underlying graves disease in patients refractory to standard immunosuppressive therapy ensured remission of itp .
besides , only anti - thyroid treatment without additional immunosuppressive treatment enabled remission of itp . in our case ,
although spontaneous remissions can be seen in graves disease , we think that immunosuppressive therapy given for the treatment of itp - induced a transient euthyroidism in graves disease . during the 6 months following itp therapy of our patient ,
whose tsh values remained at normal levels , graves disease and concomitant itp recurrences were observed , and only anti - thyroid therapy increased platelet counts to tolerable levels .
it should be kept in mind that immunosuppressive therapy without considering thyroid function tests may result in a transient euthyroid state , which potentially masks graves disease accompanying immunosuppressive therapy and associated recurrent itp attacks .
 a 71-year - old female patient followed primary immune thrombocytopenia ( itp ) was admitted to endocrinology unit with excessive sweating . 
 we started methimazole for graves disease . without any additional immunosuppressive treatment , at week 12 of methimazole therapy 
 , thyroid stimulating hormone ( tsh ) levels returned to normal , and platelet counts rose to tolerable levels . 
 when her hospital records were analyzed , they revealed that a year ago , when she had been diagnosed with itp , her tsh values had been suppressed . 
 after immunosuppressive therapy , her platelet values were maintained at normal levels , and during her control visits , her tsh levels were measured twice and were within normal limits . 
 we think that immunosuppressive therapy for itp without considering thyroid function tests may result in a transient euthyroid state , which potentially masks graves disease accompanying immunosuppressive therapy and associated recurrent itp attacks . 
Introduction
Case Report
Discussion
Conclusion