Propylthiouracil-induced agranulocytosis: An unusual presentation and a possible mechanism

Mant, Madeleine; Shivji, Salma; Ginsberg, Jody

doi:10.1016/0002-9343(88)90701-2

Cited by 9 publications

(10 citation statements)

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“…Agranulocytosis may develop at any time or after the first course of propylthiouracil treatment (25). Although most cases of propylthiouracil‐induced agranulocytosis occur within the first 3 months of treatment, few cases are reported on second exposure (26,27). For our patient 1, it is interesting to observe the development of agranulocytosis after previous courses of propylthiouracil treatment.…”

Section: Discussionmentioning

confidence: 99%

“…It is reported that drug‐induced neutropenia is an immune‐mediated reaction and antineutrophil antibodies could be responsible for propylthiouracil‐induced neutropenia (28). Therefore possible mechanism for agranulocytosis following previous successful treatment courses might be the sensitisation by re‐exposures after the drug had been stopped (27).…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic plasmapheresis in patients with severe hyperthyroidism in whom antithyroid drugs are contraindicated

Özbey¹,

Kalayoğlu-Beşışık²,

Gül³

et al. 2004

International Journal of Clinical Practice

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Four patients with Graves' disease in whom antithyroid drugs could not be used were treated by plasmapheresis preoperatively. On admission all patients had severe hyperthyroidism. All patients were treated by beta blockers, cholestyramine and inorganic iodine before plasmapheresis. Plasmapheresis course consisted of three sessions. Removed plasma was replaced by a synthetic colloid solution and human albumin other than fresh-frozen plasma. Plasmapheresis led to decreases in serum T3 concentrations >78-40% and free T4 concentrations >69%. Near-total thyroidectomy could be performed in all patients. Although screening coagulation tests were within normal limits, patients 1 and 4 experienced more blood loss than usual during the operative procedure. Plasmapheresis could be used as an alternative therapeutic option in the preoperative management of severe hyperthyroid patients with contraindications to antithyroid drugs. However, this is an invasive procedure and patients should be followed carefully for prolonged clinic/subclinic coagulopathy due to plasma exchange.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Therapeutic plasmapheresis in patients with severe hyperthyroidism in whom antithyroid drugs are contraindicated

Özbey¹,

Kalayoğlu-Beşışık²,

Gül³

et al. 2004

International Journal of Clinical Practice

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“…This is inherent to the rarity of the adverse reaction. Case reports were published on all drugs listed as being frequently reported to the DSU in this article, e.g., mianserin, salazosulphapyridine, phenylbutazone, penicillamine, and dipyrone [4], the group of penicillins [5], cimetidine [6], naproxen [7], and the thiouracil derivatives [8,9], but also on drugs that were less frequently reported as a cause, such as clozapine [10][11][12], cephalosporins [13], procainamide [14], dapsone [15,16], paracetamol [17], and ticlopidine [18]. The DSU published case reports and case series on agranulocytosis attributed to aprindine [19,20], spironolactone [21], ticlopidine [22], propylthiouracil [23], pirenzepine [24], trazodone [25], and omeprazole [26], and on leukopenia attributed to mianserin [27].…”

Section: Discussionmentioning

confidence: 99%

Drug-associated agranulocytosis: 20 years of reporting in The Netherlands (1974–1994)

Klauw

Wilson²,

Stricker

1998

Am. J. Hematol.

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In this descriptive study, all 425 reports were included concerning drug-associated agranulocytosis as registered between 1974 and 1994 in the files of the Drug Safety Unit of the Dutch Inspectorate for Health Care. All reports were analysed as to the probability of agranulocytosis or neutropenia according to previously defined criteria. Subsequently , the causal relationship between exposure and outcome was assessed. It concerned 149 men and 271 women. One hundred and twelve reports were unclassifiable because age, gender, or total number of leukocytes at the time of reaction were unknown. In 100 reports agranulocytosis was probable, in 78 possible, in 8 reports neutropenia was probable, in 20 reports neutropenia was possible, and in 107 reports agranulocytosis or neutropenia were unlikely. In the 13 reports of probable agranulocytosis or neutropenia with a certain causal relationship, causative drugs were cimetidine, dipyrone, sulphasala-zine, methyldopa, spironolactone, propylthiouracil (2), thiamazole, sulphamethoxazole with trimethoprim, gentamicin, a combination preparation containing aminophenazone, benzylpenicillin and indomethacin. The individual drugs most often reported to cause agranulocytosis or neutropenia were: dipyrone (19), mianserin (15), sulphasalazine (13), sulphamethoxazole with trimethoprim (11), the group of penicillins (9), cimetidine (8), the thiouracil derivatives (8), phenylbutazone (8), and penicillamine (8). Agranulocytosis is a serious and fairly frequently reported adverse reaction. The reporting system of the Drug Safety Unit can be used very well for signal generation concerning adverse reactions to drugs. Am.

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“…Agranulocytosis is defi ned as a decrease of the number of granulocytes to < 500 per mm 3 and is reported in approximately 0.35 % of patients treated with PTU or MMI ( Tajiri and Noguchi, 2004 ). This can be caused by two mechanisms: one immune-mediated by antigranulocyte antibodies ( Berkman et al, 1983 ;Fibbe et al, 1986 ;Toth et al, 1988 ), the other correlated with direct toxic damage (the thionamides reach high concentrations in granulocytes). ( Bandyopadhyay et al, 2002 ).…”

Section: Side Eff Ectsmentioning

confidence: 99%

Medical Treatment of Hyperthyroidism: State of the Art

Fumarola

Fiore

Dainelli

et al. 2010

Exp Clin Endocrinol Diabetes

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Methimazole (MMI) and propylthiouracil (PTU) are the main antithyroid drugs used for hyperthyroidism. They inhibit the synthesis of thyroid hormone at various levels and are used as the primary treatment for hyperthyroidism or as a preparation before radioiodine therapy or thyroidectomy. MMI is the drug of choice because of its widespread availability, longer half-life and small number of severe side effects. Drugs of second choice are potassium perchlorate, beta blockers, iodine, lithium carbonate and glucocorticoids. Rituximab, a monoclonal antibody directed against human CD20, was recently proposed as a biological therapy for cases of Graves' disease unresponsive to traditional drugs.

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Propylthiouracil-induced agranulocytosis: An unusual presentation and a possible mechanism

Cited by 9 publications

References 0 publications

Therapeutic plasmapheresis in patients with severe hyperthyroidism in whom antithyroid drugs are contraindicated

Therapeutic plasmapheresis in patients with severe hyperthyroidism in whom antithyroid drugs are contraindicated

Drug-associated agranulocytosis: 20 years of reporting in The Netherlands (1974–1994)

Medical Treatment of Hyperthyroidism: State of the Art

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