Q. I have been suffering from gum bleeding associated with choanal bleeding. Please advice

Answered by
Dr. Elina Angelova Beleva
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Apr 06, 2019

Hello doctor,

I am a 43-year-old female and have been suffering from gum bleeding and recently had episodes of posterior choanal bleeding, I was examined by a dentist and ENT surgeon and they could not find any abnormality.

I am a hypothyroid patient and I had to stop taking medicine for it due to low TSH level. I have also been suffering from thrombocytopenia for long. I am post-menopausal for the past seven years. Please advise me what I should do.



Welcome to icliniq.com.

First, from what I see from the results (attachment removed to protect patient identity) is the presence of low T3 and T4 levels with elevated TSH at the same time. It means that your thyroid function is deprived again and you need to re-start hormone replacement therapy. The fact that your lipid levels are elevated speaks in favor of slowed metabolism and can be attributed to the current hypothyroid state.

Second, your platelets are borderline. At this time they are sufficient enough in quantity to exert anti-bleeding properties, so if you had bleeding at this moment, most probably it was not due to their count. But if your hypothyroidism is autoimmune in nature, the reason for which you did not mention, then there is a high chance that you have immune thrombocytopenia as well.

Usually, one autoimmune disorder goes together with another. But even if you have immune thrombocytopenia, at the current platelet count it would not require any treatment. The hypothyroidism requires though. You have a slight increase in eosinophils. Again, they are borderline, but nevertheless, this prompts investigation for parasites such as echinococcosis, leishmaniasis, toxocariasis are the ones that are more frequent in your region.

Next, do you take any medications that could potentially inhibit platelet function? Such as Aspirin, Clopidogrel or do you eat a lot of garlic? Then, if there is no drug substance causing dysfunction of platelets, you will need to check your coagulation with conventional tests such as APTT, PT, and INR. Last, but not the least, this could be a case of inherited plate dysfunction, but that you should have had since early childhood.

And finally, I assume you had your differential manually checked by a laboratory specialist and they did not found any abnormal cells on the smear. You also have not mentioned whether the dentist reported on gum hypertrophy, but I assume there is none. You can take some Vitamin C, you might be lacking it, and Rutascorbin to prevent capillary fragility.

The Probable causes:

Hashimoto thyroiditis.

Investigations to be done:

Parasitologic tests, coagulation tests: APTT, INR, PT.

Differential diagnosis:

Platelet dysfunction.

Treatment plan:

Ascorbic acid (Vitamin C) 500 mg daily for two weeks,
Rutoside (Rutascorbine) 20 mg twice daily.

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