ROBERT S. PINALS, M.D.; RUSSELL H. TOMAR, M.D.; DAVID C. HAAS, M.D.; FUAD FARAH, M.D.
To the editor: A case of thyroiditis, myasthenia gravis, and idiopathic thrombocytopenic purpura was reported recently by Segal and Weintraub (Ann Intern Med 85:761-762). We have seen a similar patient who had Graves' disease rather than thyroiditis.
A 36-year-old Lebanese woman developed a goiter, exophthalmos, and symptoms of hyperthyroidism in 1955, with remission after a subtotal thyroidectomy. The histologic picture of thyroiditis was not present. In 1959 ecchymosis, hematuria, and gastrointestinal bleeding led to a diagnosis of idiopathic thrombocytopenic purpura. The platelet count was as low as 8000/mm3. Bone-marrow examination showed abundant megakaryocytes. Prednisone therapy produced temporary improvement and a
PINALS RS, TOMAR RH, HAAS DC, FARAH F. Graves' Disease, Myasthenia Gravis, and Purpura. Ann Intern Med. ;87:250. doi: 10.7326/0003-4819-87-2-250_2
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Published: Ann Intern Med. 1977;87(2):250.
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