To the Editor.—
Edward R. Eichner, MD, and Charles L. Whitfield, MD, presented an excellent algorithmic approach to the diagnosis of splenomegaly (1981;246:2858). However, there is one omission that strikes an endocrinologist immediately: thyrotoxicosis. In the article by Baldridge and Peterson (1927;88:1701) they describe 144 patients with exopthalmic goiter, of which 44 had palpable spleens. Other authors have reported the induction of lymphoid hyperplasia and splenomegaly by thyroxine in experimental animals.1,2In the 73 patients I have seen with thyrotoxicosis, there have been three with generalized prominent lymphadenopathy that resolved after correction of the thyrotoxicosis. Two of the 73 had easily palpable splenomegaly as well as thrombocytopenia and leukopenia, a syndrome previously reported.3 One of the two with decreased platelets had undergone a splenectomy before it was discovered he had thyrotoxicosis. Splenomegaly resolved in the second patient when a euthyroid state was achieved following sodium iodide I 131
Marynick SP. Splenomegaly in Thyrotoxicosis. JAMA. 1982;247(20):2782. doi:10.1001/jama.1982.03320450020022
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