I have thrombocytopenia. Should I adjust the Eltrombopag dose?

Question

Hello doctor,

I am a 34-year-old woman diagnosed with chronic immune thrombocytopenia two years ago. My platelet count has been fluctuating between 25,000 and 35,000/μL over the past six months.

I am currently on Eltrombopag 50 mg daily. In addition to ITP, I have Hashimoto’s thyroiditis, and my latest thyroid function test showed TSH at 9.2 mIU/L and free T4 at 0.6 ng/dL. Recently, I have been feeling unusually fatigued and lightheaded, and have noticed some new petechiae on my legs.

My hemoglobin dropped slightly to 10.2 g/dL, and my CRP is mildly elevated at 12 mg/L. I have also had occasional palpitations and mild swelling in my ankles.

I am worried whether the thyroid issue or an underlying flare of ITP is causing these new symptoms. Should my Eltrombopag dose be adjusted?
Do I need a repeat thyroid antibody test, or is this typical with Hashimoto’s?
Also, are there risks of interaction between my ITP treatment and Levothyroxine, which I was advised to start?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for sharing all of this so clearly. I understand how overwhelming it can be to manage more than one autoimmune condition at the same time, especially when new symptoms appear.

Your recent TSH (thyroid-stimulating hormone) and free T4 (thyroxine) levels suggest that your Hashimoto’s is now in a more active (hypothyroid) phase. This alone can cause fatigue, lightheadedness, palpitations, and even mild fluid retention.

Starting Levothyroxine seems appropriate, and it is not known to interfere directly with Eltrombopag, but it is very important to take the two medications several hours apart because Eltrombopag can reduce the absorption of thyroid hormone due to its effect on minerals.

At the same time, the appearance of new petechiae and the slight drop in hemoglobin may indicate a flare in your ITP (immune thrombocytopenic purpura), possibly triggered by inflammation or the thyroid imbalance itself.

The elevated CRP (C-reactive protein) suggests that something inflammatory is happening. So, I would recommend a few things:

Repeat CBC (complete blood count) in the coming days to monitor platelets and hemoglobin.
Possibly adjusting the Eltrombopag dose, but only after confirming a sustained drop in platelets or an increase in symptoms.
Starting Levothyroxine at a low dose and increasing slowly under supervision.
No urgent need to repeat thyroid antibody tests unless there’s diagnostic doubt, because they tend to stay positive once diagnosed with Hashimoto’s.

I hope this helps you.

For more queries, feel free to reach out to me anytime.

Thank you.