Death Due to Agranulocytosis Induced by Methimazole Therapy

Specht, Norman W.

doi:10.1001/jama.1952.72930280001009

Cited by 25 publications

(4 citation statements)

References 9 publications

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“…There have been two fatal cases reported. Both were related to pneumonia with or without agranulocytosis 3 , 8 ) . In the remaining cases, the clinical symptoms and laboratory abnormalities became normal when methimazole was discontinued, or with the use of corticosteroids 8 ) .…”

Section: Discussionmentioning

confidence: 96%

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A Case of Methimazole-Induced Acute Hepatic Failure in A Patient with Chronic Hepatitis B Carrier

Kang

Choi

Jung

et al. 1990

Korean J Intern Med

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We report a case of methimazole-induced acute hepatic failure, which occurred 17 weeks after initiation of the drug in a 43-year-old man with hyperthyroidism and hepatitis B surface antigenemia. Postmortem needle autopsy of the liver revealed an established micronodular cirrhosis secondary to hepatitis B with moderate septal/portal inflammation, marked cholestasis and scattered acidophilic bodies. The serum hepatitis B surface antigen (HBsAg) was positive, but reactivation of hepatitis B was unlikely in view of the absence of a serum hepatitis B e antigen (HBeAg) and hepatitis B virus deoxyribonucleic acid (HBV-DNA) and negative stain for HBsAg and hepatitis B core antigen (HBcAg) in the liver tissue.

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Section: Discussionmentioning

confidence: 96%

“…Drug-induced hepatitis seems to be a very rare toxic reaction by this drug. Only 15 documented cases have been reported 3 – 17 ) . None of these reports mentioned acute hepatic failure induced by methimazole.…”

Section: Introductionmentioning

confidence: 99%

A Case of Methimazole-Induced Acute Hepatic Failure in A Patient with Chronic Hepatitis B Carrier

Kang

Choi

Jung

et al. 1990

Korean J Intern Med

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“…The patient was receiving methimazole and had previously had agranulocytosis secondary to propylthiouracil treatment. The first death associated with ATD therapy also dates from 1952 [ 5 ], when a patient receiving methimazole developed high fever and dyspnea and eventually died of bilateral pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Antithyroid Drug-Induced Agranulocytosis: State of the Art on Diagnosis and Management

et al. 2017

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Agranulocytosis is a rare but serious complication of antithyroid drug therapy, and an up-to-date understanding of this topic is important. Both direct toxicity and immune-mediated responses have been described as possible mechanisms. Some major susceptibility loci have recently been identified, which may lead the diagnosis of agranulocytosis into a genomic era. Onset is acute and patients present with symptoms and signs of infection together with high fever. Clinical suspicion is pivotal and should prompt blood sampling. An absolute neutrophil count of <500/μl in the presence of antithyroid drugs establishes the diagnosis. The causative drug should immediately be stopped to prevent further damage. Treatment includes broad-spectrum antibiotics and granulocyte-colony stimulation factor in selected patients. Later, patients will need definitive treatment for hyperthyroidism, usually with radioactive iodine or surgery. The best way to avoid the mortality associated with antithyroid drug-induced agranulocytosis is patient education.

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“… 16 In 1952, a patient receiving methimazole experienced severe bilateral pneumonia and succumbed to it, which was the first mortality related to ATD treatment. 17 Absolute neutrophil count (ANC) below 500/l of blood has been identified as a marker for drug-induced agranulocytosis. 18 In actuality, most patients have an ANC below 100/l.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic Propylthiouracil Induced Agranulocytosis in a Patient with Toxic Nodular Goiter: A Rare Case Report

Shale,

Umer,

Tola

et al. 2023

IMCRJ

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Background Agranulocytosis is a rare but fatal side effect of antithyroid drugs (ATDs) with incidence reported at 0.1%‐1%. Agranulocytosis is defined as a granulocyte count <500 cells/μL following the use of ATDs and is an absolute contraindication to the use of these drugs; in this case, radioactive iodine (RAI) or surgery are therapeutic options. Case Presentation A 28-year-old female patient was on follow-up at our clinic after she presented with anterior neck swelling of 4 years. The patient was started on propylthiouracil (PTU) and propranolol based on clinical symptoms of hyperthyroidism and low thyroid stimulating hormone (TSH) levels. After taking the ATDs for 7 months, she came to the clinic for her regular follow-up. At this point, she was declared euthyroid and booked for surgery. Investigations were sent and the complete blood count (CBC) result showed leucopenia with agranulocytosis, even though she was completely asymptomatic. The offending ATD was immediately discontinued. The patient was kept inpatient for monitoring, and lugol’s iodine and propranolol were initiated. Eight days after discontinuing the ATD, the CBC profile was determined once again, showing normalized total leukocyte, as well as, absolute neutrophil count. Eventually, the multinodular goiter (MNG) was managed with subtotal thyroidectomy. Conclusion Despite the fact that agranulocytosis is an extremely rare side effect of ATDs, most often PTU; it is a potentially fatal complication when it occurs. Patient education at the time of prescription should not be overlooked, and systematic programs should be put in place. The baseline granulocyte count should be determined and monitored on a regular basis.

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Death Due to Agranulocytosis Induced by Methimazole Therapy

Abstract: interpreted as evidence of improved exercise tolerance.In two patients (cases 1

Cited by 25 publications

References 9 publications

A Case of Methimazole-Induced Acute Hepatic Failure in A Patient with Chronic Hepatitis B Carrier

A Case of Methimazole-Induced Acute Hepatic Failure in A Patient with Chronic Hepatitis B Carrier

Antithyroid Drug-Induced Agranulocytosis: State of the Art on Diagnosis and Management

Asymptomatic Propylthiouracil Induced Agranulocytosis in a Patient with Toxic Nodular Goiter: A Rare Case Report

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