A case of antithyroid drug‐induced agranulocytosis from a second antithyroid drugs (<scp>ATD</scp>) administration in a relapsed Graves' disease patient who was tolerant to the first <scp>ATD</scp> treatment

Kim, Hyunsam; Lee, Jeongmin; Ha, Jeonghoon

doi:10.1002/ccr3.1644

Cited by 5 publications

(3 citation statements)

References 17 publications

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“…The best prevention is to educate patients when prescribing antithyroid drugs. Robinson et al reported that 60.9% of patients were not aware of the symptoms of agranulocytosis and 30% of these patients after investigation, found the fact that patients did not receive an explanation of agranulocytosis so that they experienced delays in diagnosis which could result in an increased risk of mortality (6,17,18).…”

Section: Preventionmentioning

confidence: 99%

Diagnosis And Management Of Antithyroid Drug Induced Agranulocytosis

Debbyousha

Zufry²

2022

Proceedings of Malikussaleh International Conference on Health

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Agranulocytosis as adversed effect of antithyroid drug (ATD) in patients with Graves disease is a rare complication but it can be serious and life threatening. The mortality rate 2-10% caused by severe infection as complications. Immediate diagnosis and management are essential for proper treatment and good prognosis. A 35-year-old female with Graves disease was complaining of fever and sore throat. She was initially treated with Thiamizole 1x20 mg for 2 weeks. Physical examination revealed leukoplakia and diffuse struma. Laboratory test : FT4 43 pmol/L, TSHs :0,005 uIu/mL, ANC <100/ul. Patient is diagnosed with ATD induced agranulocytosis. Treatment includes meropenem, fluconazole and GCSFs. The clinical and laboratory parameter improved after two weeks of treatment. Agranulocytosis in Graves’ disease patient which had ATD is a rare occurrence, with an incidence 0,2- 0,5% (66,7% had severe infection). The diagnostic criteria for agranulocytosis caused by ATD are hyperthyroid patients who are confirmed with an increase T4 and/or T3, decrease in TSH, ANC of 1500/ul before receiving ATD, ANC < 500/ul after initiation ATD and other causes of agranulocytosis have been excluded. In fact, most patients had ANC <100/ul. There are no symptom difference with agranulocytosis caused by other cause. High fever and sore throat are the most common symptom. Initial management are to identify, immediately stop the drug use, broad spectrum antibiotics and GCSFs. The hyperthyroidism will continue and alternative therapies should still be given. The best prevention is to educate patient and to examine granulocyte count frequently.

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Section: Preventionmentioning

confidence: 99%

Diagnosis And Management Of Antithyroid Drug Induced Agranulocytosis

Debbyousha

Zufry²

2022

Proceedings of Malikussaleh International Conference on Health

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“…Conversely, other studies have found that thionamide-induced neutropenia is independent of dose, age, duration of treatment, or second exposure to the drug [9] Patients with Grave's disease may occasionally course with neutropenia before initiating treatment wit h tionamides, due to the unpredictable and idiosyncratic nature; for this reason, most experts recommend monitoring the blood count [10] It is important to educate the patient about this complication, and is instructed to discontinue the drug, if he has fever and sore throat. The prognosis of drug-induced neutropenia has improved with advances in supportive therapy, including antibiotics, blood transfusions, and the use of granulocytic colony-stimulating factor (GM-CSF) [11].…”

Section: American Journal Of Biomedical Science and Researchmentioning

confidence: 99%

Tionamide Agranulocytosis, A Complication Fearednot to Forget

Calvo

2021

AJBSR

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An unusual case of a 49-year-old female patient with a history of hyperthyroidism in management with mettimazole 40mg/day is presented. Quien is admitted to the ICU with a picture of febrile neutropenia secondary to agranulocytosis caused by the toxic effect of metymazole and the development of septic shock. When performing the assertive diagnosis, the drug was immediately discontinued and therapy with granulocytic colony growth factor was initiated, later the patient presents successful clinical improvement, is discharged from the ICU and continued its management in the general ward.

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“…According to literatures, we summarize the antithyroid arthritis syndrome as [1] a patient was diagnosed hyperthyroidism; [2]who developed arthritis after treating with antithyroid drugs; [3] who noted the typical symptom of migratory multi-joint pain, [4]occurred within 2-3 months secondary to the use of antithyroid drugs; [5] the symptoms resolved shortly or relieved after discontinuing drug; [6] No joint deformities remain; [7]No past history of arthritis4-6. Given that the present case developed arthritis 1 month after the patient started receiving methiamazole, we diagnosed Antithyroid arthritis syndrome.…”

Section: Case Reportmentioning

confidence: 99%