fd7d7070b308432dc2b29cd73e32a7bd 320333.pdf 89530bd712b254d2e6f69a87b04ed5825e9518dd 320333.pdf 33b932422a673d15b8d4a0ec629f95f3989cfe06bc0ed8897aab9fb3b62750b1 320333.pdf Title: Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study Subject: Background: Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/L) is a rare but serious complication in the treatment of hyperthyroidism. Methodology: Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves’ disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. Results: The median (IQR) time to development of agranulocytosis was 6.0 (4.0–11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves’ disease), and two patients died of septic shock secondary to AIA. Conclusions: AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously. Keywords: antithyroid drug-induced agranulocytosis (AIA); carbimazole (CBZ); methimazole (MMI); propylthiouracil (PTU) Author: Carlos García Gómez, Elena Navarro, Victoria Alcázar, Antonio López-Guzmán, Francisco Arrieta, Emma Anda, Betina Biagetti, Fernando Guerrero-Pérez, Carles Villabona, Andrés Ruiz de Assín Valverde, Cristina Lamas, Beatriz Lecumberri, José Antonio Rosado Sierra, Julia Sastre, Juan José Díez and Pedro Iglesias Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Oct 17 09:44:13 2023 CEST ModDate: Tue Oct 17 10:14:35 2023 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 283929 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- XAWNGI+VnURWPalladioL Type 1 Custom yes yes no 10 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 15 0 BHZWYO+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 EKQSNT+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 PXVMAF+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 JYPLJJ+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 50 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 53 0 TDUDTH+CMSY10 Type 1 Builtin yes yes no 75 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-10-29 04:43:41 CET RepresentationInformation: 320333.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-10-28 11:49:39 CET Size: 283929 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 270 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Patients Destination: subsection.2.1 Item: Title: Study Design Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: General and Demographic Characteristics Destination: subsection.3.1 Item: Title: Data Related to Hyperthyroidism Destination: subsection.3.2 Item: Title: Data Related to Agranulocytosis Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Item: Title: References Destination: section.5 Info: Title: Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study Author: Carlos García Gómez, Elena Navarro, Victoria Alcázar, Antonio López-Guzmán, Francisco Arrieta, Emma Anda, Betina Biagetti, Fernando Guerrero-Pérez, Carles Villabona, Andrés Ruiz de Assín Valverde, Cristina Lamas, Beatriz Lecumberri, José Antonio Rosado Sierra, Julia Sastre, Juan José Díez and Pedro Iglesias Subject: Background: Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/L) is a rare but serious complication in the treatment of hyperthyroidism. Methodology: Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves’ disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. Results: The median (IQR) time to development of agranulocytosis was 6.0 (4.0 11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves’ disease), and two patients died of septic shock secondary to AIA. Conclusions: AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously. 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