Document Detail


Antithyroid drug-induced agranulocytosis: report of 13 cases.
MedLine Citation:
PMID:  17760275     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Antithyroid drug (ATD)-induced agranulocytosis is rare but may cause fatal complications in patients with thyrotoxicosis during treatment with thionamide-derived drugs. From our previous experience, we note that 2 of 11 such patients died in a 10-year retrospective study. METHODS: We reviewed thirteen patients who developed agranulocytosis from 7,466 patients with hyperthyroidism while they were being treated with ATD from July 1989 to November 2003. RESULTS: The incidence of ATD-induced agranulocytosis (absolute neutrophil counts < 500/mm3) was 0.17%. The age of the 13 patients (female: male = 10:3) was 28 to 61 years (mean +/- SD: 39.6 +/- 10.0 years). The most common clinical manifestations were fever (100%), sore throat (76.9%) and chills (46.1%). At the time of agranulocytosis attack, ATD had been administered for 12 to 66 days (mean +/- SD: 36.4 +/- 18.7 days) and the duration of symptoms was 1 to 14 days (mean +/- SD: 4.6 +/- 3.7 days). Intravenous infusion of 300 microg granulocyte colony-stimulating factor (G-CSF) per day was administered to 3 patients simultaneously with intravenous empirical broad-spectrum antibiotics. After intensive and supportive treatment in hospital, all the patients recovered with absolute neutrophil counts of more than 500/mm3 in 2 to 13 days (mean +/- SD: 7.6 +/- 3.4 days). CONCLUSIONS: In our 25-year clinical experience, the most cost-effective method of managing agranulocytosis induced by thionamide-derived ATD is that all patients with thyrotoxicosis must be warned that their white blood cells and differential counts should be checked immediately whenever the "common cold" symptoms occur during treatment, especially within the first 3 months of medication.
Authors:
Chung-Huei Huang; Kay-Lun Li; Jin-Hou Wu; Po-Nan Wang; Jyuhn-Huarng Juang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chang Gung medical journal     Volume:  30     ISSN:  2072-0939     ISO Abbreviation:  Chang Gung Med J     Publication Date:    2007 May-Jun
Date Detail:
Created Date:  2007-08-31     Completed Date:  2007-09-25     Revised Date:  2008-12-16    
Medline Journal Info:
Nlm Unique ID:  101088034     Medline TA:  Chang Gung Med J     Country:  China (Republic : 1949- )    
Other Details:
Languages:  eng     Pagination:  242-8     Citation Subset:  IM    
Affiliation:
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, ROC.
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MeSH Terms
Descriptor/Qualifier:
Adult
Agranulocytosis / chemically induced*,  complications,  drug therapy
Antithyroid Agents / adverse effects*
Bacterial Infections / etiology
Female
Granulocyte Colony-Stimulating Factor / therapeutic use
Humans
Male
Middle Aged
Chemical
Reg. No./Substance:
0/Antithyroid Agents; 143011-72-7/Granulocyte Colony-Stimulating Factor

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