Propylthiouracil-induced agranulocytosis as a rare complication of antithyroid drugs in a patient with Graves’ disease

Abstract

SUMMARY INTRODUCTION: Graves’ disease (GD) is an autoimmune disorder characterized by hyperthyroidism. Antithyroid drugs (ATDs) are available as therapy. Agranulocytosis is a rare but potentially fatal complication of this therapy. In this study, we report agranulocytosis induced by propylthiouracil (PTU) in a patient with GD and the difficulties of clinical management. CASE: RNBA, male, 30 years old, with GD, treated with propylthiouracil (PTU). He progressed with pharyngotonsillitis. Then, PTU was suspended and antibiotic, filgrastim, propranolol, and prednisone were initiated. Due to the decompensation of hyperthyroidism, lithium carbonate, dexamethasone, and Lugol's solution were introduced. Total thyroidectomy (TT) was performed with satisfactory postoperative progression. DISCUSSION: We describe here the case of a young male patient with GD. For the treatment of hyperthyroidism, thioamides are effective options. Agranulocytosis induced by ATDs is a rare complication defined as the occurrence of a granulocyte count <500/mm3 after the use of ATDs. PTU was suspended, and filgrastim and antibiotics were prescribed. Radioiodine (RAI) or surgery are therapeutic alternatives. Due to problems with ATD use, a total thyroidectomy was proposed. The preoperative preparation was performed with beta-blocker, glucocorticoid, lithium carbonate, and Lugol solution. Cholestyramine is also an option for controlling hyperthyroidism. TT was performed without postoperative complications. CONCLUSION: Thionamide-induced agranulocytosis is a rare complication. With a contraindication to ATDs, RAI and surgery are definitive therapeutic options in GD. Beta-blockers, glucocorticoids, lithium carbonate, iodine, and cholestyramine may be an adjunctive therapy for hyperthyroidism.

Propylthiouracil: A Thyro-Suppressive as well as Haemato-Suppressive to Induce Agranulocytosis in Hyperthyroid Patients

“…Majority of the agranulocytosis cases reported in 90 days after the commence of therapy. The patients should receive instruction from physicians and report if any symptoms observed such as pancytopeniatemperature, sore throat/pharyngitis, diarrhea [16]. In recent study the potentially fatal side effects agranulocytosis was reported in 2.7% of patients and fever (80%), and sore throat (82%) was reported within 3 months after onset of therapy.…”

Cross-sectional investigation of serum creatine kinase concentration in Graves disease patients treated with oral antithyroid drugs

“…They include pruritus, skin rashes, agranulocytosis, hepatic injury, aplastic anemia, and so on. [ 6 – 8 ] In addition, we noticed that some patients with GD treated with oral ATDs manifested symptom of myalgia. CK is a muscle-specific kinase.…”

“…Oral ATDs’ common side effects include: rash, pruritus, liver damage, and leukopenia. [ 6 , 7 ] But there are some other rare adverse reactions, such as aplastic anemia, [ 8 ] increased serum creatine kinase (CK) that are easily ignored. We noticed that some GD patients with oral ATDs manifested myalgia and increased serum CK concentration.…”

Diagnosis And Management Of Antithyroid Drug Induced Agranulocytosis

“…Pancytopenia was found in 1.2% of patients with agranulocytosis due to antithyroid drugs. Hemopoetic damage can be found in patients without any clinical manifestations, so it is necessary to consider a complete count examination after 2 weeks of taking anti-thyroid drugs (6,12,14,15).…”