Antithyroid drugs can be a rare cause of agranulocytosis (0.5% of treated patients). Suspension of these drugs is mandatory in these patients and may result in worsening hyperthyroidism. We report the case of a 27-year-old woman who is 3 months post-partum, breastfeeding, and suffering with Graves' disease hyperthyroidism treated first with methimazole and then with propylthiouracil due to a methimazole allergy. She was admitted for urosepsis and agranulocytosis. The patient was diagnosed with propylthiouracil related agranulocytosis, diffuse toxic goiter and thyro-gastric syndrome. Antithyroid drug therapy was stopped resulting in a worsening of thyrotoxicosis. Agranulocytosis was treated with 8 doses of G-CSF with full recovery. To rapidly restore euthyroidism and to perform a thyroidectomy, the patient received 6 therapeutic plasma exchange (TPE) procedures, to clear thyroid hormones and anti-TSH receptor antibodies from blood, resulting in a pre-surgical euthyroid state without antithyroid drug therapy. Two years after thyroidectomy, the patient is well under thyroid hormone replacement therapy with a normal granulocyte count.

Graves' disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and G-CSF followed by total thyroidectomy / Candoni, A.; De Marchi, F.; Vescini, F.; Mauro, S.; Rinaldi, C.; Piemonte, M.; Rabassi, N.; Dubbini, M. V.; Fanin, R.. - In: MEDITERRANEAN JOURNAL OF HEMATOLOGY AND INFECTIOUS DISEASES. - ISSN 2035-3006. - 9:1(2017), pp. 2017058-2017062. [10.4084/mjhid.2017.058]

Graves' disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and G-CSF followed by total thyroidectomy

Candoni A.
;
2017-01-01

Abstract

Antithyroid drugs can be a rare cause of agranulocytosis (0.5% of treated patients). Suspension of these drugs is mandatory in these patients and may result in worsening hyperthyroidism. We report the case of a 27-year-old woman who is 3 months post-partum, breastfeeding, and suffering with Graves' disease hyperthyroidism treated first with methimazole and then with propylthiouracil due to a methimazole allergy. She was admitted for urosepsis and agranulocytosis. The patient was diagnosed with propylthiouracil related agranulocytosis, diffuse toxic goiter and thyro-gastric syndrome. Antithyroid drug therapy was stopped resulting in a worsening of thyrotoxicosis. Agranulocytosis was treated with 8 doses of G-CSF with full recovery. To rapidly restore euthyroidism and to perform a thyroidectomy, the patient received 6 therapeutic plasma exchange (TPE) procedures, to clear thyroid hormones and anti-TSH receptor antibodies from blood, resulting in a pre-surgical euthyroid state without antithyroid drug therapy. Two years after thyroidectomy, the patient is well under thyroid hormone replacement therapy with a normal granulocyte count.
9
1
2017058
2017062
Graves' disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and G-CSF followed by total thyroidectomy / Candoni, A.; De Marchi, F.; Vescini, F.; Mauro, S.; Rinaldi, C.; Piemonte, M.; Rabassi, N.; Dubbini, M. V.; Fanin, R.. - In: MEDITERRANEAN JOURNAL OF HEMATOLOGY AND INFECTIOUS DISEASES. - ISSN 2035-3006. - 9:1(2017), pp. 2017058-2017062. [10.4084/mjhid.2017.058]
Candoni, A.; De Marchi, F.; Vescini, F.; Mauro, S.; Rinaldi, C.; Piemonte, M.; Rabassi, N.; Dubbini, M. V.; Fanin, R.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1293955
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