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Unusual peripheral smear in hypothyroidism
, Zerubabel Girma Tesso2
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Received: ,
Accepted: ,
How to cite this article: Tesfaye MH, Asnake MA, Yohannes KG, Melak MM, Tekle AB, Tesso ZG. Unusual peripheral smear in hypothyroidism. J Pediatr Endocrinol Diabetes. doi: 10.25259/JPED_22_2025
The thyroid hormones play a crucial role in hematopoiesis, particularly in promoting the proliferation and maturation of immature progenitor red blood cells, and the function of white blood cells (WBCs), specifically in the development and maturation of B-cells. They also influence the overall WBC count.[1,2] We present here an exceptional case report describing immature WBC on peripheral blood morphology (PBM) secondary to hypothyroidism in a 2-year-old male child with myxedema, mimicking acute leukemia [Figure 1].[2] This was evidenced by the complete disappearance of blast cells from PBM [Figure 2] after thyroid hormone replacement therapy, together with associated manifestations of hypothyroidism seen in the patient.[3] Peripheral blood film of myxedema due to untreated congenital hypothyroidism could include immature WBCs, which could disappear with thyroid replacement treatment.[4,5] Evidence shows that thyroid hormone is not directly involved in thrombocytopoiesis but that increased concentrations of this hormone minimize the life span of thrombocytes. Dysfunction of thyroid hormones (hyperthyroidism and hypothyroidism) affects the production, differentiation, function, and survival of almost all blood cells. This case image highlights this unusual hematological manifestation in untreated hypothyroidism.[5]
- Initial peripheral blood morphology, showing blast cell and hypersegmented neutrophil (Arrow head, oil immersion,100×).
- Normal peripheral smear after correction of hypothyroidism (oil immersion,100×).
Ethical approval:
The Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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