Antithyroid Drug-Induced Hematopoietic Damage: A Retrospective Cohort Study of Agranulocytosis and Pancytopenia Involving 50,385 Patients with Graves' Disease

Abstract

This study showed that ATD cause hematopoietic changes, which are occasionally severe and potentially fatal. The pathogenesis of agranulocytosis and pancytopenia might overlap, and additional studies are warranted to clarify this and to establish an optimal treatment strategy.

The Effects of GCSF on the Recovery Time and Duration of Hospitalization in Patients with Anti-thyroid Drug-Induced Agranulocytosis in a Tertiary Hospital

“…[14][15][16][17][18][19][20] In studies done by Watanabe, Andres and Tamai, GCSF shortened the recovery period from agranulocytosis. 1,16,18,19 GCSF was ineffective against ATD-induced agranulocytosis in a prospective controlled study. 15 The cost of GCSF is also an important issue for both the patient and physician, particularly in emerging countries such as the Philippines.…”

“…1 The ATDs are associated with a variety of minor side effects as well as potentially life-threatening complications such as agranulocytosis. 2 Agranulocytosis is defined as an ANC of less than 500 cells/µL or 0.5 x 10 9 , which carries a very high risk for infection.…”

“…2,3 The occurrence of ATD-induced agranulocytosis is uncommon, in less than 0.1% to 0.5% of hyperthyroid patients on either thiamazole or propylthiouracil. 1,2 It has an incidence rate of 3 in every 10,000 patients per year. 4 In 2008, agranulocytosis was also found in 0.37% and 0.35% of hyperthyroid patients receiving propylthiouracil (PTU) and methimazole (MMI), respectively.…”

“…Fifty-four patients treated with GCSF recovered significantly earlier (7 days, range 2 to 22 days) than those who did not receive GCSF (9 days, 4 to 21 days) (p=0.004). 1 A local retrospective analysis done in 2008 by Macaballug studied the severity of ATD-induced agranulocytosis in 14 patients. Two out of the 14 patients were given GCSF.…”

The relationship between bone marrow characteristics and the clinical prognosis of antithyroid drug-induced agranulocytosis

“…Its incidence, however, was much lower than that of agranulocytosis. To date, there were only 42 cases of ATD-induced aplastic anemia reported [15][16]. It has been suggested that the most likely mechanism for ATD-induced aplastic anemia was also an autoimmune humoral reaction against myeloid stem cells rather than granulocyte progenitor cells and mature circulating neutrophils [2,[17][18].…”