Antithyroid Drug-induced Agranulocytosis

Abstract

Antithyroid drugs are widely used to treat hyperthyroidism, especially Graves' disease, but they tend to cause agranulocytosis, which increases the mortality rate. Granulocyte colony-stimulating factor decreases the duration of recovery from agranulocytosis. We retrospectively studied cases of antithyroid drug-induced agranulocytosis over the past 10 years in a northern Taiwan medical center. A clinical evaluation was conducted, including a review of complete blood cell counts and differential counts. Four cases were included in this analysis. Agranulocytosis persisted in 2 cases despite a change in therapy from propylthiouracil to methimazole. Fever, sore throat, and diarrhea were common symptoms of agranulocytosis. Initial white blood cell counts ranged from 450 to 1,710/microL. Only 1 case had a positive result from a throat swab culture (Staphylococcus aureus). Three of 4 cases received granulocyte colony-stimulating factor therapy, and the recovery time ranged from 3 to 13 days. All of the patients recovered from agranulocytosis. We concluded that: (1) conducting a routine complete blood cell count is beneficial in alerting caregivers to the possibility of agranulocytosis; (2) educating patients about the common symptoms of agranulocytosis may contribute to an early diagnosis; (3) providing granulocyte colony-stimulating factor therapy to patients results in good prognosis; and (4) monitoring for cross-reactions between drugs should be performed to prevent further episodes of agranulocytosis.

Agranulocytosis due to propylthiouracil treatment: a case report

“…Antitiroid ilaç kullanımına bağlı ortaya çıkan agranü-lositozun mekanizması tam olarak bilinmese de direkt toksik etkilerle ve immünolojik mekanizmalara bağlı olarak ortaya çıktığı düşünülmektedir (3,10). Dolaşımdaki olgun nötrofiller ve kök hücreler direk toksik etki nedeniyle zarar görürken, immünglobulin E ilişkili hipersensitivite reaksiyonu, ilaç ilişkili immünglobulin G ve M cevabı ve nötrofil-ilaç komplekslerinin oluşumu immünolojik hasarın nedenleri olduğu düşünülmektedir (3,10).…”

“…Dolaşımdaki olgun nötrofiller ve kök hücreler direk toksik etki nedeniyle zarar görürken, immünglobulin E ilişkili hipersensitivite reaksiyonu, ilaç ilişkili immünglobulin G ve M cevabı ve nötrofil-ilaç komplekslerinin oluşumu immünolojik hasarın nedenleri olduğu düşünülmektedir (3,10).…”

“…PTU'nun birçok sistemle ilişkili yan etkileri vardır; ancak bunlardan agranülositoz nadir görülmesine rağmen en ciddi olanıdır (3). Bu hayatı tehdit eden komplikasyon genellikle tedavi başladıktan 1-4 ay sonra ortaya çıkmaktadır ve görülme ihtimali dozdan bağımsızdır (4).…”

Relationship Between Leukopenia and Intercellular Adhesion Molecules in Graves’ Disease

“…Graves' disease with leukopenia involves complex factors (9,10). In addition to ATD side effects, abnormal haematopoietic function or hyperthyroidism may be considered.…”

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

“…Therefore, it may affect the microenvironment of bone marrow and inhibit the generation and differentiation of pluripotent hematopoietic stem cells. The immunological reactions include the immunoglobulin (Ig) E-mediated hypersensitivity reaction, drug-induced IgG and IgM responses, and antineutrophil cytoplasm antibodies (ANCA) associated immune injury, which might contribute to agranulocytosis [1,7,[12][13]. Bone marrow characteristics may be valuable in revealing the tion of the 33 cases, there were 15 cases with bone marrow active proliferation, 3 cases with hyperplasia and 2 cases with hypoplasia in type I, while 3 cases with hyperplasia and 10 cases with active proliferation were indentified in type II.…”