Hashimoto’s Thyroiditis is an autoimmune disease which leads to the destruction of thyroid follicular cells through immune-mediated processes. Its overall prevalence is 7.5%, and is known to be more common in women. Prevalence increases with age, especially in patients diagnosed with other autoimmune conditions, such as myasthenia gravis, systemic sclerosis and other connective tissue diseases, Sjögren’s syndrome, pernicious anemia, autoimmune liver disease, and celiac disease.

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We present a 72-year-old Filipino woman with a one-month history of melena, multiple cutaneous hematomas, and persistent hyponatremia. Thyroid workups were done revealing multinodular nontoxic goiter with subclinical hypothyroidism: FT3 2.87 pmol/L (normal: 3.8 - 6.0), FT4 pmol/L (normal: 8.72 7.9 - 14.4), TSH 6.02 uIU/mL (normal: 0.34 - 5.6). Neck ultrasound showed multiple bilateral nodules, with largest at right upper lobe (1.53 x 0.90 x 1.42 cm, complex, isoechoic, with microcalcifications TIRADS 4) and left mid segment (1.22 x 0.73. x 0.90 cm, complex, isoechoic, with microcalcifications, TIRADS 4). Notably, patient has osteoporosis with a history of fracture, previous pulmonary tuberculosis infection, but no hypertension nor diabetes mellitus. No thyroid medications were started but there were plans were to do further workups as outpatient. However, patient was readmitted three weeks after due to persistence of melena with accompanying shortness of breath. Patient was persistently anemic with an initial Hemoglobin of 33 despite multiple blood transfusions hence was referred to Hematology service. The APTT performed on a 50:50 mix of patient's plasma with normal plasma and tested immediately was 55.6 seconds. Anti- FVIII assay, Lupus anticoagulant, and Bethesda assay were requested but not done due to financial constraints. Endocrinology wise, antithyroid peroxidase antibody test was 8.08 IU/mL (normal <5.61) and repeat thyroid function test were FT3 1.58, FT4 10.5 TSH 7.4. The final diagnosis was primary hypothyroidism secondary to Hashimoto’s Thyroiditis, Anemia secondary to Acquired Hemophilia A. Patient was maintained on Levothyroxine 50 mcg once a day and Hydrocortisone 100mg IV every 12 hours then eventually shifted to Prednisone 20mg 2 tabs once a day.

Hashimoto’s Thyroiditis coexisting with Hemophilia A is a rare occurrence and should be documented as to highlight detection and improve outcomes.