Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center
<b>Background:</b> The most important series devoted to antithyroid drug-induced severe neutropenia and agranulocytosis are Japanese studies, almost specifically in relation to the intake of methimazole. The clinical data of 30 Caucasian patients followed up for antithyroid drug-induced...
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doaj-f437daee109e4de69f721abc39f254072020-11-25T01:41:51ZengMDPI AGMedicines2305-63202020-03-01731510.3390/medicines7030015medicines7030015Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference CenterEmmanuel Andrès0Noel Lorenzo-Villalba1Rachel Mourot-Cottet2Frédéric Maloisel3Martine Tebacher4Jacques-Eric Gottenberg5Bernard Goichot6Raoul Herbrecht7Abrar-Ahmad Zulfiqar8Departments of Internal Medicine, Strasbourg University Hospitals, 67000 Strasbourg, FranceDepartments of Internal Medicine, Strasbourg University Hospitals, 67000 Strasbourg, FranceDepartments of Internal Medicine, Strasbourg University Hospitals, 67000 Strasbourg, FranceOnco-Hematology, Strasbourg University Hospitals, 67000 Strasbourg, FranceRegional Pharmacovigilance Centre of Alsace, 67000 Strasbourg, FranceRheumatology, Strasbourg University Hospitals, 67000 Strasbourg, FranceDepartments of Internal Medicine, Strasbourg University Hospitals, 67000 Strasbourg, FranceOnco-Hematology, Strasbourg University Hospitals, 67000 Strasbourg, FranceDepartments of Internal Medicine, Strasbourg University Hospitals, 67000 Strasbourg, France<b>Background:</b> The most important series devoted to antithyroid drug-induced severe neutropenia and agranulocytosis are Japanese studies, almost specifically in relation to the intake of methimazole. The clinical data of 30 Caucasian patients followed up for antithyroid drug-induced neutropenia at a third-level hospital are reported. <b>Methods:</b> The data of 30 patients with idiosyncratic antithyroid drug-induced neutropenia and agranulocytosis from a cohort study on drug-induced neutropenia and agranulocytosis conducted at the University Hospital of Strasbourg (France) were retrospectively reviewed. <b>Results:</b> The mean patient age was 61.7 years old (range: 20−87), and the gender ratio (F/M) was 4. Several comorbidities were reported in 23 patients (76.7%), with the mean Charlson comorbidity index of 1. The causative drugs were carbimazole and benzylthiouracil, in 28 (93.3%) and 2 cases, respectively, prescribed primarily for multi-hetero-nodular goiter or thyroid nodule to 18 patients (60%). Sore throat and acute tonsillitis (40%), isolated fever (20%), septicemia (13.3%), documented pneumonia (6.7%), and septic shock (6.7%) were the main clinical features upon admission. The mean neutrophil count at nadir was 0.02 and 0 × 10<sup>9</sup>/L (range: 0−0.3). Regarding the patients’ hospital course: 13 cases (43.3%) worsened during hospitalization, severe sepsis was found in 26.7%, systemic inflammatory response syndrome—in 13.3%, and septic shock—in 3.3% of the cases, respectively. Broad-spectrum antibiotics were indicated for all the patients, and 21 (73.3%) of them received hematopoietic growth factors. Hematological recovery (neutrophil count ≥ 1.5 × 10<sup>9</sup>/L) was seen at 8.3 days (range: 2−24), but faster in those receiving hematopoietic growth factors (4.9 days, <i>p</i> = 0.046). Two patients died during hospitalization, and the rest had a favorable clinical outcome. <b>Conclusions:</b> Antithyroid drug-induced neutropenia represents a serious complication resulting from the rates of severe infections especially in those cases severe neutropenia. In this setting, an established procedure for the management of patients seems useful or even indispensable in view of potential mortality.https://www.mdpi.com/2305-6320/7/3/15neutropeniaagranulocytosisantithyroid drugcarbimazolepropylthiouracildiagnosisfeverinfectionhematopoietic growth factorgranulocyte colony-stimulating factor |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Emmanuel Andrès Noel Lorenzo-Villalba Rachel Mourot-Cottet Frédéric Maloisel Martine Tebacher Jacques-Eric Gottenberg Bernard Goichot Raoul Herbrecht Abrar-Ahmad Zulfiqar |
spellingShingle |
Emmanuel Andrès Noel Lorenzo-Villalba Rachel Mourot-Cottet Frédéric Maloisel Martine Tebacher Jacques-Eric Gottenberg Bernard Goichot Raoul Herbrecht Abrar-Ahmad Zulfiqar Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center Medicines neutropenia agranulocytosis antithyroid drug carbimazole propylthiouracil diagnosis fever infection hematopoietic growth factor granulocyte colony-stimulating factor |
author_facet |
Emmanuel Andrès Noel Lorenzo-Villalba Rachel Mourot-Cottet Frédéric Maloisel Martine Tebacher Jacques-Eric Gottenberg Bernard Goichot Raoul Herbrecht Abrar-Ahmad Zulfiqar |
author_sort |
Emmanuel Andrès |
title |
Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center |
title_short |
Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center |
title_full |
Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center |
title_fullStr |
Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center |
title_full_unstemmed |
Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center |
title_sort |
severe neutropenia and agranulocytosis related to antithyroid drugs: a study of 30 cases managed in a single reference center |
publisher |
MDPI AG |
series |
Medicines |
issn |
2305-6320 |
publishDate |
2020-03-01 |
description |
<b>Background:</b> The most important series devoted to antithyroid drug-induced severe neutropenia and agranulocytosis are Japanese studies, almost specifically in relation to the intake of methimazole. The clinical data of 30 Caucasian patients followed up for antithyroid drug-induced neutropenia at a third-level hospital are reported. <b>Methods:</b> The data of 30 patients with idiosyncratic antithyroid drug-induced neutropenia and agranulocytosis from a cohort study on drug-induced neutropenia and agranulocytosis conducted at the University Hospital of Strasbourg (France) were retrospectively reviewed. <b>Results:</b> The mean patient age was 61.7 years old (range: 20−87), and the gender ratio (F/M) was 4. Several comorbidities were reported in 23 patients (76.7%), with the mean Charlson comorbidity index of 1. The causative drugs were carbimazole and benzylthiouracil, in 28 (93.3%) and 2 cases, respectively, prescribed primarily for multi-hetero-nodular goiter or thyroid nodule to 18 patients (60%). Sore throat and acute tonsillitis (40%), isolated fever (20%), septicemia (13.3%), documented pneumonia (6.7%), and septic shock (6.7%) were the main clinical features upon admission. The mean neutrophil count at nadir was 0.02 and 0 × 10<sup>9</sup>/L (range: 0−0.3). Regarding the patients’ hospital course: 13 cases (43.3%) worsened during hospitalization, severe sepsis was found in 26.7%, systemic inflammatory response syndrome—in 13.3%, and septic shock—in 3.3% of the cases, respectively. Broad-spectrum antibiotics were indicated for all the patients, and 21 (73.3%) of them received hematopoietic growth factors. Hematological recovery (neutrophil count ≥ 1.5 × 10<sup>9</sup>/L) was seen at 8.3 days (range: 2−24), but faster in those receiving hematopoietic growth factors (4.9 days, <i>p</i> = 0.046). Two patients died during hospitalization, and the rest had a favorable clinical outcome. <b>Conclusions:</b> Antithyroid drug-induced neutropenia represents a serious complication resulting from the rates of severe infections especially in those cases severe neutropenia. In this setting, an established procedure for the management of patients seems useful or even indispensable in view of potential mortality. |
topic |
neutropenia agranulocytosis antithyroid drug carbimazole propylthiouracil diagnosis fever infection hematopoietic growth factor granulocyte colony-stimulating factor |
url |
https://www.mdpi.com/2305-6320/7/3/15 |
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