Research Article
Volume 3 Issue 8 - 2020
Antithyroid Drug-Induced Agranulocytosis: Management Challenges: Experience from 10 Cases
Mohammad Fariduddin1, Marufa Mustari2, Tania Tofail3*, Shahjada Selim4, Tahniyah Haq4, Sharmin Jahan4, Murshed Ahamed Khan4, Nusrat Sultana4, Hurjahan Banu2, Fatima Begum5 and Muhammad Abul Hasanat5
1Professor and Chairman, Bangabandhu Shiekh Mujib Medical University, Shahbag, Dhaka, Bangladesh
2Fellow, Bangabandhu Shiekh Mujib Medical University, Shahbag, Dhaka, Bangladesh
3Resident, Bangabandhu Shiekh Mujib Medical University, Shahbag, Dhaka, Bangladesh
4Assistant Professor, Bangabandhu Shiekh Mujib Medical University, Shahbag, Dhaka, Bangladesh
5Professor, Bangabandhu Shiekh Mujib Medical University, Shahbag, Dhaka, Bangladesh
*Corresponding Author: Tania Tofail, Resident, Bangabandhu Shiekh Mujib Medical University, Shahbag, Dhaka, Bangladesh.
Received: April 23, 2020; Published: July 06, 2020


Aim: To share our experience of Antithyroid drug (ATD)-induced agranulocytosis. Agranulocytosis is a well-recognized fatal complication of ATD.

Methods: We managed ten patients of ATD induced agranulocytosis and we used standardized case record form to collect data.

Results: Of the 10 cases the dose of Carbimazol used were 30 to 80 mg/day (mean ± SD: 43.75 ± 5.81 mg/day) for 10 to 84 days. The absolute neutrophil counts were < 500/mm3 in 7 and < 1000 in all cases. The age ranged from 20 to 68 years and female 75%. Clinically all (100%) cases had fever and sore throat. Bleeding gum and epistaxis in 3 cases and sepsis and shock were present in 3 cases. Carbimazol was stopped in all cases; of which 2 were inadvertently switched to PTU but developed agranulocytosis again. All cases recovered following withdrawal of drugs and supportive management. Radio-ablation was done in all cases. Initially one case was managed with lugol’s iodine therapy and another one with plasmapheresis. Rests were managed with lithium. It took two to three weeks for response (50% of baseline FT4 level) with 800 - 1000 mg lithium/day.

Conclusion: Patients given ATD must report for “fever and sore throat”. Lithium is effective to control hyperthyroidism prior to radio-ablation in patients of agranulocytosis.

Keywords: Agranulocytosis; Antithyroid Drugs; Hyperthyroidism; Lithium; Radioablation


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Citation: Tania Tofail., et al. “Antithyroid Drug-Induced Agranulocytosis: Management Challenges: Experience from 10 Cases”. EC Clinical and Medical Case Reports 3.8 (2020): 01-06.

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