Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis : A Retrospective, Multicenter Study
García Gómez, Carlos (Universidad Autónoma de Madrid)
Navarro Vives, Elena (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Alcázar, Victoria (Hospital Universitario Severo Ochoa)
López-Guzmán, Antonio (Complejo Asistencial de Ávila)
Arrieta, Francisco (Hospital Universitario Ramón y Cajal (Madrid))
Anda, Emma (Complejo Hospitalario de Navarra)
Biagetti, Betina (Hospital Universitari Vall d'Hebron)
Guerrero-Pérez, Fernando (Hospital Universitari de Bellvitge)
Villabona, Carles (Hospital Universitari de Bellvitge)
de Assín Valverde, Andrés Ruiz (Complejo Hospitalario Universitario de Albacete)
Lamas, Cristina (Complejo Hospitalario Universitario de Albacete)
Lecumberri, Beatriz (ospital Universitario La Paz (Madrid))
Rosado Sierra, José Antonio (Hospital Universitario de Getafe (Madrid))
Sastre, Julia (Complejo Hospitalario de Toledo)
Díez, Juan José (Universidad Autónoma de Madrid)
Iglesias, Pedro (Universidad Autónoma de Madrid)

Data:	2023
Resum:	Background: Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/µL) 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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Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Antithyroid drug-induced agranulocytosis (AIA) ; Carbimazole (CBZ) ; Methimazole (MMI) ; Propylthiouracil (PTU)
Publicat a:	Journal of clinical medicine, Vol. 12 (october 2023) , ISSN 2077-0383

DOI: 10.3390/jcm12206556
PMID: 37892693

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