Despite therapy, platelet cycling persisted, prompting re-evaluation and repeated workup, including HIV, hepatitis, thyroid function tests, thyroid peroxidase antibodies, autoimmune disorders such as systemic lupus erythematosus and rheumatoid arthritis, vitamin B12 level, folate level, a tick-borne panel, and flow cytometry analysis for acute leukemias and myeloid/lymphoid neoplasms, all of which were unremarkable. Here, TPO is linked to rheumatoid arthritis.