Methimazole‐induced Agranulocytosis in Japanese Patients With Graves’ Disease

Abstract

We reviewed the records of approximately 7000 Japanese patients whose hyperthyroidism was treated with methimazole (MMI) alone. Four patients (Group I) developed agranulocytosis during a second course of MMI therapy and eight patients (Group II) during an initial course. Six patients (three in each group) received less than 30 mg MMI daily. Agranulocytosis occurred after more than 2 months of therapy (12 weeks-1 year) in five patients. Seven patients were less than 40 years of age. One patient displayed a gradual protracted development of agranulocytosis. These results indicate that agranulocytosis after MMI may occur irrespective of dose, age, duration of treatment, and with a second exposure.

Managing toxic thyroid adenoma: a cost-effectiveness analysis

“…Short-term complications of surgery included hematoma and transient vocal cord paralysis, transient hypothyroidism, and anesthesia-related death. Major complications of ATD therapy including agranulocytosis, hepatitis and vasculitis (9,29,30) occurred at both 7 weeks and 6 months after the start of therapy. They resulted in hospitalization, the discontinuation of ATDs, or death.…”

Agranulocitose e tonsilite associadas ao uso de metimazol

“…The less uncommon side effect of the use of thyourea, even though very important, is agranulocytosis 1 . It may be present regardless of age, dose and treatment duration 8 , even though Meyer-Gebner et al have reported higher incidence with higher doses 6 . It has sudden onset and affects 0.2 to 0.3% of the patients 8,9 .…”

“…It may be present regardless of age, dose and treatment duration 8 , even though Meyer-Gebner et al have reported higher incidence with higher doses 6 . It has sudden onset and affects 0.2 to 0.3% of the patients 8,9 . Tamai et al, after a review of 7,000 patients with diagnosis of Basedow-Graves, found agranulocytosis in only 12 patients with incidence of 0.17% Based on this side effect, patients need to be instructed to stop medication and get in contact with their physician in case of fever or infection, especially of the oropharynx, considering that the clinical evidence of infections associated with the use of anti-thyroid drugs is usually symptomatic in this region 1,8,9 .…”

“…It has sudden onset and affects 0.2 to 0.3% of the patients 8,9 . Tamai et al, after a review of 7,000 patients with diagnosis of Basedow-Graves, found agranulocytosis in only 12 patients with incidence of 0.17% Based on this side effect, patients need to be instructed to stop medication and get in contact with their physician in case of fever or infection, especially of the oropharynx, considering that the clinical evidence of infections associated with the use of anti-thyroid drugs is usually symptomatic in this region 1,8,9 . Periodontal, periapical and oral mucosa infections tend to aggravate quite quickly and they are the main foci of infection, and gram negative are the most common agents 10 .…”

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

“…11 However, another study on a Japanese population found that the occurrence of ATD-induced agranulocytosis was not associated with dose, age and treatment duration. 12 Age, sex and type of ATD were not associated with any significant difference in the occurrence of agranulocytosis based on local data. 13 In 1990, granulocyte colony-stimulating factor, a recombinant human hematopoietic growth factor used to decrease infection associated with neutropenia caused by the myelosuppression from chemotherapy of cancer patients, was found to improve the ANCs of some patients with ATD-induced agranulocytosis.…”