Graves’ disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g-csf followed by total thyroidectomy.
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 from Graves’...
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| Main Author: | |
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| Format: | Article |
| Language: | English |
| Published: |
PAGEPress Publications
2017-10-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.mjhid.org/index.php/mjhid/article/view/3065 |
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| Summary: | 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 from 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 plasmapheresis procedures, to clear thyroid hormones and anti-TSH receptor antibodies from the blood, resulting in a pre-surgical euthyroid state without antithyroid drugs. One year after thyroidectomy, the patient is well on thyroid hormone replacement therapy.
Key Words: Plasmapheresis; Hyperthyroidism, Agranulocytosis; Propylthiouracil. |
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| ISSN: | 2035-3006 |