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




Abstract

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

References

  1. Cooper DS. “Antithyroid Drugs”. The New England Journal of Medicine 352.9 (2005): 905-917. 
  2. Tajiri J and Noguchi S. “Antithyroid Drug-Induced Agranulocytosis: Special Reference to Normal White Blood Cell Count Agranulocytosis”. Thyroid 14.6 (2004): 459-462. 
  3. Pearce SHS. “Spontaneous reporting of adverse reactions to carbimazole and propylthiouracil in the UK”. Clinical Endocrinology (Oxford) 61.5 (2004): 589-594. 
  4. Weetman AP. “Graves’ Disease”. The New England Journal of Medicine 343.17 (2000): 1236-1248. 
  5. Li KL., et al. “Agranulocytosis associated with anti-thyroid drug in patients with Graves’ thyrotoxicosis--report of 11 cases”. Changgeng Yi Xue Za Zhi 14.3 (1991): 168-173. 
  6. Sheng WH., et al. “Antithyroid-drug-induced agranulocytosis complicated by life-threatening infections”. QJM - Monthly Journal of the Association of Physicians 92.8 (1999): 455-461. 
  7. DS Cooper. “Treatment of thyrotoxicosis”. In Werner and Ingbar’s the Thyroid a Fundamental and Clinical Text, L. E. Braverman and D. S. Cooper, Editions (2013): 492-516, 
  8. Cooper DS., et al. “Agranulocytosis associated with antithyroid drugs. Effects of patient age and drug dose”. Annals of Internal Medicine 98.1 (1983): 26-29. 
  9. Mori M., et al. “Inhibitory Effect of Lithium on the Release of Thyroid Hormones from Thyrotropin-Stimulated Mouse Thyroids in a Perifusion System”. Endocrinology 124.3 (1989): 1365-1369. 
  10. Williams JA., et al. “Thyroid Secretion in Vitro: Inhibition of TSH and Dibutyryl Cyclic-AMP Stimulated 131 I Release by Li + 1”. Endocrinology 88.6 (1971): 1385-1388. 
  11. Spaulding SW., et al. “The Inhibitory Effect of Lithium on Thyroid Hormone Release in Both Euthyroid and Thyrotoxic Patients”. The Journal of Clinical Endocrinology and Metabolism 35.6 (1972): 905-911. 
  12. Schwartz J., et al. “Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue”. Journal of Clinical Apheresis 31.3 (2016): 149-162. 
  13. Jha S., et al. “Thyroid Storm Due to Inappropriate Administration of a Compounded Thyroid Hormone Preparation Successfully Treated with Plasmapheresis”. Thyroid 22.12 (2012): 1283-1286. 
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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