Graves' disease with severe neutropenia: Any clues?

Hegazi, Mohamed Osama; Almansour, Ammar; Nawara, Abdallah

doi:10.1111/cen.13398

Cited by 2 publications

(2 citation statements)

References 3 publications

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“…The time to recovery from neutropenia was revealed by two studies 11,13 indicating that it could range from 14 to 55 days, and occurring in parallel with the restoration of euthyroidism. A similar time (ie 60 days) was required to obtain the normalization of a severe neutropenia (ANC 0.2 × 10 9 /L) after therapy with carbimazole in the case report by Hegazi et al 29 …”

Section: Discussionmentioning

confidence: 88%

Neutropenia in patients with hyperthyroidism: Systematic review and meta‐analysis

Scappaticcio

Maiorino

Maio

et al. 2020

Clinical Endocrinology

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Background and Objective Neutropenia, a low absolute neutrophil count (ANC), may be a sign of new‐onset hyperthyroidism. The aim of this systematic review and meta‐analysis was to provide the most reliable estimates of prevalence, degree and response to treatments of neutropenia in the pure hyperthyroidism setting. Methods A comprehensive literature search was performed in PubMed and Scopus databases for retrieving articles in English and non‐English languages reporting ANC values/neutropenic cases at presentation and after therapy in patients with hyperthyroidism. A proportion meta‐analysis was performed with DerSimonian and Laird method (random‐effects model). Pooled data were presented with 95% confidence intervals (95% CI) and displayed in a forest plot. I2 statistic index was used to quantify the heterogeneity among the studies. Sensitivity analyses for the prevalence of neutropenia and the mean of ANC in hyperthyroid patients were performed by excluding the studies without full details. Trim and fill analysis and Egger's linear regression test were carried out to evaluate the publication bias. A two‐sided P‐value of <.05 was regarded as significant for all analyses. The National Heart, Lung and Blood Institute Quality Assessment Tool was used to evaluate the quality of studies included. Results The literature search yielded 1880 studies of which 13 studies were included for systematic review and meta‐analysis. Results of the meta‐analysis demonstrated that the prevalence of neutropenia in newly diagnosed and untreated patients with Graves’ hyperthyroidism was 10% (CI 5%‐19%, I2 88.6%) and summary mean ANC value in neutropenic was 1.4 ± 0.3 × 109/L. In all neutropenic patients under ATD therapy neutropenia resolved, thus without the worsening of the baseline ANC values or the development of agranulocytosis. The sensitivity analyses showed similar results as those of the main analyses. For all outcomes, the publication bias was not statistically significant or not calculable. Conclusions Graves’ disease per se is associated with neutropenia in about 10% of cases. Neutropenia usually appears as a mild to moderate laboratory abnormality with no detectable consequences. Subnormal/mild neutropenia should not be regarded as a contraindication to use ATDs, and clinicians should know that treating hyperthyroidism they have a significant chance to normalize ANC too.

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Section: Discussionmentioning

confidence: 88%

Neutropenia in patients with hyperthyroidism: Systematic review and meta‐analysis

Scappaticcio

Maiorino

Maio

et al. 2020

Clinical Endocrinology

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show abstract

“…The time to resolution of neutropenia in two studies was 14-55 days and occurred in parallel with the restoration of euthyroidism [10,18]. A similar time frame (60 days) was required to achieve the normalisation of severe neutropenia (ANC 0.2 × 10 9 /L) after treatment with carbimazole in a case study by Hegazi et al [19].…”

Section: Evolution Of Neutropeniamentioning

confidence: 84%

Treatment of Graves' Disease Associated With Severe Neutropenia

Laidi¹,

Motaib²,

Elamari³

et al. 2022

Cureus

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Severe neutropenia in newly diagnosed hyperthyroidism is a diagnostic and therapeutic dilemma since antithyroid drugs (ATDs) cannot be started if the absolute neutrophil count (ANC) is <1 x 10 9 /L. We report the case of a patient followed for hyperthyroidism associated with severe neutropenia treated with dexamethasone and ATD. The patient was 51 years old and was hospitalized for hyperthyroidism with a thyroid stimulating hormone (TSH) level <0.005 (0.4-4) mUI/L, T4 at 415 (9.3-17.1) ng/L and T3 at 148 (2-4.4) pg/mL on Graves' disease (GD) confirmed by the TSH receptor antibodies at 38 IU/mL and scintigraphy, associated with neutropenia, with ANC at 0.4 x 10 9 /L. He was put on prednisolone 60 mg/day and propranolol 60 mg/day for three weeks without improvement. Faced with the association of hyperthyroidism and severe neutropenia, we could not start the ATD for fear of agranulocytosis; we put the patient on propranolol 60 mg and dexamethasone 6 mg with progressive degression resulting in a spectacular increase of ANC from 0.4 x 10 9 /L to 7.1 x 10 9 /L, which allowed us to start the ATD (carbimazole) at a dose of 30 mg, and then 50 mg, with monitoring of ANC and transaminases every 48 hours. Euthyroidism was achieved after 15 days. A curative treatment with radioactive iodine ablation was administered. Our patient did not respond to prednisolone but responded dramatically to dexamethasone; this leads us to consider using dexamethasone for the rapid preparation for radical treatment of patients with GD.

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Graves' disease with severe neutropenia: Any clues?

Cited by 2 publications

References 3 publications

Neutropenia in patients with hyperthyroidism: Systematic review and meta‐analysis

Neutropenia in patients with hyperthyroidism: Systematic review and meta‐analysis

Treatment of Graves' Disease Associated With Severe Neutropenia

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