Sepsis mimicking thyroid storm in a patient with methimazole-induced agranulocytosis

Rayner, Samuel G.; Hosseini, Faegheh; Adedipe, Adeyinka

doi:10.1136/bcr-2013-200145

Cited by 12 publications

(11 citation statements)

References 12 publications

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“…Review of the literature of reported cases of agranulocytosis between 1999 and 2013 identified 80 cases where the presenting symptoms were described [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. Fever (93.8%), sore throat (68.7%) and chills (21.2%) were the commonest presenting symptoms.…”

Section: Resultsmentioning

confidence: 99%

Patient Knowledge of Antithyroid Drug-Induced Agranulocytosis

Robinson¹,

Richardson²,

Hickey³

et al. 2014

Eur Thyroid J

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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.

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Section: Resultsmentioning

confidence: 99%

Patient Knowledge of Antithyroid Drug-Induced Agranulocytosis

Robinson¹,

Richardson²,

Hickey³

et al. 2014

Eur Thyroid J

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“…Various clinical entities that mimic thyroid storm exist, which confounds the existent diagnostic dilemma, namely, peritonitis [55], sepsis/septic shock [56], heat stroke [57], malignant hyperthermia [58], acute pulmonary edema [59], neuroleptic malignant syndrome [60], and serotonin syndrome [61]. The mimics of thyroid storm are listed in Table 5.…”

Section: Common Rarementioning

confidence: 99%

Thyroid Storm: Clinical Manifestation, Pathophysiology, and Treatment

Pandey¹,

Kumar²,

Kotwal³

2020

Goiter - Causes and Treatment

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Thyroid storm is a rare but life-threatening endocrine emergency. It is an acute exaggerated clinical manifestation of thyrotoxic state. The exact incidence is unknown. It occurs in 1-2% of patients admitted for thyrotoxicosis. It has a mortality of 10-20%. This chapter would help us to understand its clinical manifestations, pathophysiology, and effective treatment. Terminal learning objective would be to diagnose impending storm early and start prompt treatment in day-today practice. The chapter would cover pathophysiology including triggers, clinical features including various diagnostic criteria, diagnosis, and treatment of thyroid storm. Indications of surgical treatment in storm will be discussed.

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“…Agranulocytosis is a rare complication of thioamides, occurring in about 0.2-0.5% of cases. Sepsis in the setting of neutropenia is rapidly fatal if untreated and represents a medical emergency (2). Once patients who experienced an episode of thionamide-induced agranulocytosis can no longer use this drug class, definitive treatments such as total thyroidectomy or radioactive iodine therapy should be considered as first-line therapy (3).…”

Section: Introductionmentioning

confidence: 99%

“…It is important to note that a thyroid storm is often mistaken for sepsis since they both have the same cardinal features: tachycardia, diaphoresis, agitation, fever and altered level of consciousness. These two diagnoses can often be mistaken especially in patients with uncontrolled hyperthyroidism (2).…”

Section: Introductionmentioning

confidence: 99%

Methimazole-Induced Agranulocytosis and Sepsis: was Thyroid Storm Present or Just Being Mimicked?

et al. 2019

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Introduction. Agranulocytosis induced by thioamides is rare, occurring only in 0.2-0.5% of cases. Case presentation. We present the case of a 45-year-old woman previously diagnosed with Graves' disease that discontinued the use of methimazole on her own. She attended the Emergency Department presenting fever (40.5¯C), agitation and diaphoresis. A thyroid storm diagnosis was initially thought, but after laboratory results showing neutrophil count near 0.06x109/L, sepsis due to neutropenia seemed the most logical hypothesis. Cephepime was promptly initiated. For thyrotoxicosis management, cholestyramine and atenolol were prescribed. In her second day of hospitalization, subcutaneous granulocyte colonystimulating factor was started for an earlier medullar response. The patient was discharged after 7 days with atenolol 50mg/ day and instructed to have a definite treatment for Graves disease as soon as possible. Conclusion. Such case purpose is to remember clinicians that sepsis diagnosis can be challenged, especially when a thyroid storm is a possible diagnosis as well. In this particular case, both conditions should be treated, but life-threatening sepsis should have the focus for a quick therapeutic approach.

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Sepsis mimicking thyroid storm in a patient with methimazole-induced agranulocytosis

Cited by 12 publications

References 12 publications

Patient Knowledge of Antithyroid Drug-Induced Agranulocytosis

Patient Knowledge of Antithyroid Drug-Induced Agranulocytosis

Thyroid Storm: Clinical Manifestation, Pathophysiology, and Treatment

Methimazole-Induced Agranulocytosis and Sepsis: was Thyroid Storm Present or Just Being Mimicked?

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