Characteristics of Antithyroid Drug–Induced Agranulocytosis in Patients with Hyperthyroidism: A Retrospective Analysis of 114 Cases in a Single Institution in China Involving 9690 Patients Referred for Radioiodine Treatment Over 15 Years

Yang, Jun; Zhu, Yangjun; Zhong, Jijun; Zhang, Jun; Weng, Wubin; Liu, Zhenfeng; Xu, Qin; Dong, Meng‐Jie

doi:10.1089/thy.2015.0439

Cited by 38 publications

(49 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…During the preparation of this article, a retrospective analysis of 114 ATD-induced cases from China was published [15]. The result was well compatible with that of our previous study in general [2], though the incidence of AG was much higher than that in Japan (1.2 vs. 0.2-0.4%).…”

Section: Discussionsupporting

confidence: 80%

Periodic Granulocyte Count Measuring Is Useful for Detecting Asymptomatic Agranulocytosis in Antithyroid Drug-Treated Patients with Graves' Disease

et al. 2016

View full text Add to dashboard Cite

Objective: Finding agranulocytosis (AG) at an early stage is important to improve outcome, but periodic granulocyte count monitoring is not generally recommended for patients with Graves' disease, because AG develops suddenly. Method: At the Kuma Hospital, Graves' patients under antithyroid drug (ATD) treatment in an outpatient clinic have a granulocyte count examination during each visit, and if it is <1,000/μl, a warning is immediately sent to the patient's physician. We evaluated the usefulness of this system. Results: We investigated 25 AG and 33 granulocytopenia (GP) cases over a recent 5-year period, excluding patients who developed AG or GP at another hospital and were referred to us for treatment. Among the 25 AG patients, 16 patients (64%; 9 asymptomatic and 7 very mild symptomatic cases) were discovered by the periodic granulocyte count examination at an outpatient clinic. The remaining 9 patients visited the Kuma Hospital or other hospitals because of infection symptoms. Most of the AG patients were given granulocyte colony-stimulating factor injections immediately and were admitted if a prompt increase in granulocytes could not be obtained. The final treatments for Graves' disease were ¹³¹I-radioisotope therapy (19 patients), thyroidectomy (2 patients), inorganic iodine (1 patient), or another ATD (1 patient). Among the 33 GP patients, 31 (94%), including 20 asymptomatic cases, were discovered during periodic granulocyte count monitoring. Most of them stopped ATD, and other treatments for Graves' disease were selected. Conclusion: Periodic monitoring of granulocyte counts is useful for identifying AG and GP patients with no or minimum infection symptoms.

show abstract

Section: Discussionsupporting

confidence: 80%

Periodic Granulocyte Count Measuring Is Useful for Detecting Asymptomatic Agranulocytosis in Antithyroid Drug-Treated Patients with Graves' Disease

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In the case of a serious allergic reaction, prescribing the alternative drug is not recommended. Rare but major side effects [63] include hepatitis, a lupus-like syndrome, and agranulocytosis (neutrophil count < 500/mL), which occurs in 0.1-1.0% of cases [64,65]. Agranulocytosis tend to occur abruptly within 3 months after the initiation of ATD therapy [65].…”

Section: Adverse Eventsmentioning

confidence: 99%

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

Kahaly¹,

Bartalena²,

Hegedüs³

et al. 2018

Eur Thyroid J

654

650

View full text Add to dashboard Cite

Graves’ disease (GD) is a systemic autoimmune disorder characterized by the infiltration of thyroid antigen-specific T cells into thyroid-stimulating hormone receptor (TSH-R)-expressing tissues. Stimulatory autoantibodies (Ab) in GD activate the TSH-R leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion. Diagnosis of GD is straightforward in a patient with biochemically confirmed thyrotoxicosis, positive TSH-R-Ab, a hypervascular and hypoechoic thyroid gland (ultrasound), and associated orbitopathy. In GD, measurement of TSH-R-Ab is recommended for an accurate diagnosis/differential diagnosis, prior to stopping antithyroid drug (ATD) treatment and during pregnancy. Graves’ hyperthyroidism is treated by decreasing thyroid hormone synthesis with the use of ATD, or by reducing the amount of thyroid tissue with radioactive iodine (RAI) treatment or total thyroidectomy. Patients with newly diagnosed Graves’ hyperthyroidism are usually medically treated for 12–18 months with methimazole (MMI) as the preferred drug. In children with GD, a 24- to 36-month course of MMI is recommended. Patients with persistently high TSH-R-Ab at 12–18 months can continue MMI treatment, repeating the TSH-R-Ab measurement after an additional 12 months, or opt for therapy with RAI or thyroidectomy. Women treated with MMI should be switched to propylthiouracil when planning pregnancy and during the first trimester of pregnancy. If a patient relapses after completing a course of ATD, definitive treatment is recommended; however, continued long-term low-dose MMI can be considered. Thyroidectomy should be performed by an experienced high-volume thyroid surgeon. RAI is contraindicated in Graves’ patients with active/severe orbitopathy, and steroid prophylaxis is warranted in Graves’ patients with mild/active orbitopathy receiving RAI.

show abstract

“…The side effects of methimazole are dose‐dependent . Most cases (about 85%) of severe neutropenia or agranulocytosis manifest within the first 3 months after beginning the drug . Most patients who discontinue methimazole, however, show improvement over 2 to 3 weeks, as did the current patient.…”

Section: Discussionmentioning

confidence: 70%

“…[1][2][3] Methimazole is a thioamide. 3 Studies in east Asian countries [4][5][6] report that more women than men are susceptible to antithyroid drug-induced neutropenia. There is evidence for genetic susceptibility in certain populations.…”

Section: Introductionmentioning

confidence: 99%

Severe Gingival Ulceration and Necrosis Caused by an Antithyroid Drug: One Case Report and Proposed Clinical Approach

Chang

Tseng²,

Yuan

2018

Clin Adv Periodontics

View full text Add to dashboard Cite

Introduction Diffuse gingival ulceration and necrosis is one of the major manifestations of neutropenia or agranulocytosis. Acquired neutropenia can be induced by many medications. Severe oral pain might induce a patient to seek the help of a dentist. It is important for dentists to be familiar with drug‐induced neutropenia and its associated oral manifestations. Case Presentation An Asian woman was diagnosed with Graves disease (hyperthyroidism) and was treated with methimazole for about 6 weeks when oral symptoms first occurred. Sore throat, fever, and extensive, painful gingival necrosis were her chief complaints when she visited the emergency department. Methimazole‐induced neutropenia was diagnosed based on her blood tests and medical history. Methimazole was replaced with a range of treatments, including injections of broad spectrum antibiotics and granulocyte colony stimulating factor. Superficial debridement and a chlorhexidine plus lidocaine mouthwash were used to control her periodontal microbiota. Within 1 week, blood data of the patient had returned to normal, and the severity of oral symptoms began to diminish. Complete healing of the gingival tissues was noted 8 months after she had been discharged from the hospital. Conclusions Methimazole induces neutropenia and subsequent gingival ulceration and necrosis in some patients. Early confirmation of the effect of methimazole and early discontinuation of the drug are the first steps to recovery. Reducing bacterial load by chemotherapeutic methods and maintaining acceptable oral hygiene are important to control the disease.

show abstract

Characteristics of Antithyroid Drug–Induced Agranulocytosis in Patients with Hyperthyroidism: A Retrospective Analysis of 114 Cases in a Single Institution in China Involving 9690 Patients Referred for Radioiodine Treatment Over 15 Years

Cited by 38 publications

References 24 publications

Periodic Granulocyte Count Measuring Is Useful for Detecting Asymptomatic Agranulocytosis in Antithyroid Drug-Treated Patients with Graves' Disease

Periodic Granulocyte Count Measuring Is Useful for Detecting Asymptomatic Agranulocytosis in Antithyroid Drug-Treated Patients with Graves' Disease

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

Severe Gingival Ulceration and Necrosis Caused by an Antithyroid Drug: One Case Report and Proposed Clinical Approach

Contact Info

Product

Resources

About