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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PAGEPress Publications
2017-10-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
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| Online Access: | http://www.mjhid.org/index.php/mjhid/article/view/3065 |
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| author | Anna Candoni |
| author_facet | Anna Candoni |
| author_sort | Anna Candoni |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-e3bdce280a184f1e89cf81c2e0f935e1 |
| institution | OA Journals |
| issn | 2035-3006 |
| language | English |
| publishDate | 2017-10-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Mediterranean Journal of Hematology and Infectious Diseases |
| spelling | doaj-art-e3bdce280a184f1e89cf81c2e0f935e12025-08-20T02:08:34ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062017-10-0191e2017058e201705810.4084/mjhid.2017.0581714Graves’ disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g-csf followed by total thyroidectomy.Anna Candoni0Division of Hematology and SCT, University of udineAntithyroid 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.http://www.mjhid.org/index.php/mjhid/article/view/3065PlasmapheresisHyperthyroidism, AgranulocytosisPropylthiouracil . |
| spellingShingle | Anna Candoni Graves’ disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g-csf followed by total thyroidectomy. Mediterranean Journal of Hematology and Infectious Diseases Plasmapheresis Hyperthyroidism, Agranulocytosis Propylthiouracil . |
| title | Graves’ disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g-csf followed by total thyroidectomy. |
| title_full | Graves’ disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g-csf followed by total thyroidectomy. |
| title_fullStr | Graves’ disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g-csf followed by total thyroidectomy. |
| title_full_unstemmed | Graves’ disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g-csf followed by total thyroidectomy. |
| title_short | Graves’ disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g-csf followed by total thyroidectomy. |
| title_sort | graves disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g csf followed by total thyroidectomy |
| topic | Plasmapheresis Hyperthyroidism, Agranulocytosis Propylthiouracil . |
| url | http://www.mjhid.org/index.php/mjhid/article/view/3065 |
| work_keys_str_mv | AT annacandoni gravesdiseasethyrotoxicosisandpropylthiouracilrelatedagranulocytosissuccessfullytreatedwiththerapeuticplasmaexchangeandgcsffollowedbytotalthyroidectomy |