Patient Knowledge of Antithyroid Drug-Induced Agranulocytosis

Abstract

Background: Agranulocytosis is a serious side effect of antithyroid drugs. Objective: To ascertain the knowledge of patients and review the quality of information available on the internet. Methods: A questionnaire survey was performed for patients receiving antithyroid drugs. Patients attending endocrine clinics who were receiving antithyroid drug treatment (group A, n = 33) were interviewed. A further national cohort of patients (group B, n = 100) treated with antithyroid drugs, participated in an online survey. Results: 60.9% of responders were not aware of the common symptoms of agranulocytosis. 18.6% had never received any information about side effects. Of the 108 patients who recalled receiving information, 30% rated the quality as ‘poor' or ‘not good at all'. Structured interviews of group A patients revealed that almost half (45.5%, 15/33) had experienced symptoms that could be indicative of agranulocytosis, but only 53.3% (8/15) had a blood count checked. A review of 20 selected patient information internet sites revealed a significant variation in advice given to patients. Conclusions: Inadequate knowledge about agranulocytosis among patients receiving antithyroid drug treatment is common. The available information on the internet is variable and inconsistent.

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

“…Knowledge about AG among Graves' patients remains still inadequate, as reported recently [16]. In addition, although in approximately 85% of the cases AG presents within 3 months after the start of ATD therapy [2], continued vigilance against AG is important, especially for patients with poor drug compliance, since some of the patients in the present study developed AG near or after 1 year.…”

Hyperthyroidism

“…Patients usually present with fever or sore throat, or both, and sometimes with other less common symptoms such as chills, diarrhoea, and myalgia. 79 The annual incidence of agranulocytosis has been estimated to be 0·1–0·3%, 80,81 and generally occurs within 90 days after initiation of therapy. When patients receiving ATDs present with these symptoms, a white blood cell count with differential should be obtained and the ATD should be immediately discontinued if the granulocyte count is less than 1000 cells/mm³.…”

“…A survey showed a lack of knowledge of this potentially serious side-effect in patients taking ATDs. 79 Other very rare haematological side-effects of ATDs include aplastic anaemia, thrombocytopenia, and hypoprothrombinaemia. 56 …”

Associations of HLA genotypes with antithyroid drug‐induced agranulocytosis: A systematic review and meta‐analysis of pharmacogenomics studies

“…The onset of ATD‐induced agranulocytosis may be abrupt, but patients are usually asymptomatic. More than half of patients are unaware of the common symptoms of agranulocytosis . Prevention is the best way for agranulocytosis, including patient education for symptoms of agranulocytosis at time of ATD prescription and monitoring of absolute neutrophil count at each visit .…”

“…More than half of patients are unaware of the common symptoms of agranulocytosis. 37 Prevention is the best way for agranulocytosis, including patient education for symptoms of agranulocytosis at time of ATD prescription and monitoring of absolute neutrophil count at each visit. 6,7 Pharmacogenomicsguided treatment may be an alternative strategy to prevent ATD-induced agranulocytosis.…”