methimazole agranulocytosis treatment

T4 = thyroxine; T3 = triiodothyronine; PTU = propylthiouracil. Found insideThis book is a practical, evidence-based resource covering thyroid disease and its effects on reproduction and fertility, discussing thyroid function and dysfunction - hypothyroidism and hyperthyroidism, thyroid nodules and cancer - during ... eCollection 2017 Oct. Ferguson P, Holder R, Mengel MB, Schwiebert LP. Agranulocytosis treatment includes: Antibiotics: If you have an infection, your healthcare provider will prescribe antibiotics and other medications to relieve your symptoms. Sorheim JI, The first death associated with ATD therapy also dates from 1952 [ 5 ], when a patient receiving methimazole developed high fever and dyspnea and eventually died of bilateral pneumonia. Schneider AB, Akin P. Stop using methimazole and call your doctor right away if you have signs of infection such as: Aloisio V, Furthermore, rhG-CSF significantly shortened recovery time when the peripheral granulocyte count was greater than 0.1 x 10(9)/L (group C2) compared with patients whose counts were less than 0.1 x 10(9)/L (group C1), 2.2 +/- 0.4 vs. 8.6 +/- 1.3 days, respectively (P < 0.001). Agranulocytosis is a potentially a life-threatening adverse reaction of Methimazole therapy. Methimazole-induced leukopenia was suspected and the drug was immediately stopped. Turnbridge WM, et al. Manetti L, 2002;87:3583–9. de Meyer PH, Lundholm K, Methimazole-induced agranulocytosis in patients with Graves' disease is more frequent with an initial dose of 30 mg daily than with 15 mg daily. In such cases, white-blood-cell and differential counts should be obtained to determine whether agranulocytosis has developed. Methimazole* High Agranulocytosis . 2001;26:1–5. Previously, it was reported that agranulocytosis was developed in patients administered more than 40 mg/day MMI; however, agranulocytosis developed regardless of the dosage and duration of MMI administration [1, 2]. If agranulocytosis is due to an underlying disease, that condition will be treated first. 1999 Oct;9(10):1033-5. doi: 10.1089/thy.1999.9.1033. Our patient presented with methimazole-induced agranulocytosis, and her hospital course was complicated by persistent fever, C difficile-related diarrhea, thrombocytopenia, pericarditis, and, most concerning, thyroid storm, which is associated with a mortality rate of 20% to 30% . For information about the SORT evidence rating system, see page 555 orhttps://www.aafp.org/afpsort.xml. 2d ed. This volume presents the latest global knowledge of thyroid disorders in infancy, childhood, and adolescence and represents experience and views from a panel of the world's most renowned authorities on thyroid pathophysiology and clinical ... Sasaki A, 44th ed. Vischer UM, Xiao H, Wendt J, N Engl J Med. Clark F, Tisell LE. Copyright © 2020 American Academy of Family Physicians. Yamamoto M, Recently, recombinant human granulocyte colo … A transient hypothyroidism often occurs before resolution (Figure 112).11. Older patients often present with a paucity of classic signs and symptoms, which can make the diagnosis more difficult.4 Thyroid storm is a rare presentation of hyperthyroidism that may occur after a stressful illness in a patient with untreated or undertreated hyperthyroidism and is characterized by delirium, severe tachycardia, fever, vomiting, diarrhea, and dehydration.5. Holm PA, Clin Nucl Med. Meier DA, Brill DR, Becker DV, Clarke SE, Silberstein EB, Royal HD, et al. Miltenburg DM. Some patients may take thyroid preparations to achieve weight loss. Tanda ML, Copyright © 2011 Munehiro Honda. Noguchi S, Boyle P. Each tablet contains 5 or 10 mg (43.8 or 87.6 μmol) methimazole, an orally administered antithyroid drug. The palpebral conjunctiva was anemic. Bethesda, MD 20894, Help [Effect of recombinant human granulocyte colony stimulating factor (rhG-CSF) in patients receiving chemotherapy--phase I study]. Luukkaala T, The present study was undertaken to determine the efficacy of rhG-CSF administration in patients with methimazole-induced (MMI) agranulocytosis. Trimarchi F. Found inside – Page 343Treatment of Graves' disease and the course of ophthalmopathy. ... antigen and methimazoleinduced agranulocytosis in Japanese patients with Graves disease. Thus, oral methyprednisolone and cyclosporin were added. Fukutani H, Ogawa M, Horikoshi N, Inoue K, Mukaiyama T, Nagamine D, Shinagawa K, Tabata M, Hirano A, Mizunuma N. Gan To Kagaku Ryoho. Long-term follow-up study of radioiodine treatment of hyperthyroidism. New York: McGraw-Hill, 2005:1102–10. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Reprinted with permission from Ross D. Medical diseases in women. Murakami N. Methimazole (oral and transdermal) is a safe and effective medication for the treatment of feline hyperthyroidism. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Ginsberg J. AA is very rare complication as a result of the administration of MMI [6–13]. Nedrebo BG, Woeber KA. Asahi H, Use of methimazole or propylthiouracil causes agranulocytosis in 0.1-0.5% of treated patients, and some events become life-threatening . A more recent article on hyperthyroidism is available, http://interactive.snm.org/docs/pg_ch26_0403.pdf. Kitagawa W, After discontinuation of methimazole treatment and a short course of granulocyte colony-stimulating factor, she responded successfully with clinical improvement of her symptoms and resolved neutropenia.Conclusion: Although this case is atypical, it reinforces the importance of remaining vigilant for signs of agranulocytosis throughout the . 2000;214:143–8. It could not be determined which drug was most effective, but these combinations seemed useful in our patient. Zhuang W, Peripheral blood examination showed a white blood-cell count of 0.8×109/L, with 2% neutrophils, hemoglobin concentration of 8.5 g/dL, platelet count of 3×109/L, and reticulation of red blood cells of 1.3%. Mariniello N, Found insideDevelopment of agranulocytosis during methimazole treatment predisposes to severe bacterial infections, systemic toxicity, and fever. The first death associated with ATD therapy also dates from 1952 [5], when a patient receiving methimazole developed high fever and dyspnea and eventually died of bilateral pneumonia. (ABSTRACT TRUNCATED AT 400 WORDS), MeSH Islas S, Ross D. Medical diseases in women. 18. Corvilain B, Dumont JF, Vassart G. Toxic adenoma and toxic multinodular goiter. Evered DC, One of the major manifestations of methimazole-induced neutropenia or agranulocytosis is diffuse gingival ulceration and necrosis. 6. 42. Studies have suggested that the risk of agranulocytosis is greater in older patients and that they have a higher rate of death. Its incidence, however, is much lower than that of agranulocytosis, with only 42 patients reported to date ( 2 - 13 ). With timely treatment, the outlook for agranulocytosis is better. Recently, recombinant human granulocyte colony-stimulating factor (rhG-CSF) was reported to be effective in shortening the recovery time of the neutropenia in patients undergoing chemotherapy. Shimizu K, 2000;61:1047–52. In: Werner SC, Ingbar SH, Braverman LE, Utiger RD, eds. Granulocyte colony-stimulating factor (G-CSF), glucocorticoid . Abstract. Arterial embolization: a novel approach to thyroid ablative therapy for Graves’ disease. Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole-induced agranulocytosis. Clin Endocrinol (Oxf). of Family and Community Medicine, University of Louisville, 3430 Newburg Rd., Louisville, KY 40218 (e-mail:[email protected]). Agranulocytosis is potentially a life-threatening adverse reaction of methimazole therapy. St. Louis: Mosby, 2002. Ljunggren JG, We herein describe a case of a 41-year-old woman who was previously administered methimazole . Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Agranulocytosis. Trivalle C, Bilateral nephrectomy for treatment resistant systemic lupus erythematosis and thrombotic thrombocytopenic purpura: A . The patient was treated with G-CSF after cessation of MMI, but her peripheral blood count did not recover even when she was administered a higher dosage of G-CSF for 11 days. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Buyukbese M, The aim of this case report is to describe a set of oral complications associated with methimazole-induced neutropenia and the healing of the gingiva after proper treatment. Family medicine: principles and practice. It is inexpensive, highly effective, easy to administer, and safe. Found inside​The burden of cutaneous drug reactions is significant, in both outpatient and inpatient settings, and can result in morbidity and even mortality. This book is unique in its approach to this problem. Comprehensive resource providing latest information on diagnosis and management of thyroid disorders. Covers medical and surgical treatment of both benign and malignant conditions. Tarantino L, She was diagnosed with cancer of the left breast and Graves’ disease, and was administered MMI 30 mg/day for Graves’ disease. Betteridge J, 2001;55:233–9. 2d ed. Dhekne R, Sarne DH. ATD-induced agranulocytosis occurs in 0.1-0.5% of patients with hyperthyroidism, mainly in the first 4 months after the initiation of ATD treatment ( 2, 9, 10 ). In: Carlson KJ, Eisenstat SA, eds. 2001;86:3016–21. de Stefano G, Indian J Med Sci. Methimazole (brand name Tapazole), is commonly prescribed to those who have hyperthyroidism and Graves' disease. Radiology. In severe hyperthyroidism, the removal of circulating thyroid hormones by plasmapheresis may be an effective therapeutic option. Escobar-Morreale et al. In most cases it is effective in reducing thyroid hormone levels, and while it's not doing anything for the cause of the problem, it can help to prevent someone from receiving radioactive iodine (RAI) or thyroid surgery while the underlying cause of the condition is being addressed. 21. Dale J, The occurrence of agranulocytosis in continuous ATD treatment patients is well known; however, a case of ATD agranulocytosis occurring following the discontinuation of methimazole (MMI) treatment is not a usual situation. Patients should be instructed to immediately report any symptoms suggestive of agranulocytosis, such as fever or sore throat. 4th ed. Moreover, recovery is usually prompt within 2–5 weeks from the withdrawal of MMI and the start of G-CSF, and bone marrow transplantation and antithymocyte globulin are seldom needed [6]. Torring O, Graves’ hyperthyroidism: treatment with antithyroid drugs, surgery, or radioiodine—a prospective, randomized study. Senturk H, Chest X-ray was normal. . She suffered from fever, chills and bloody diarrhoea on admission. Cigarette smoking is a risk factor for the development and progression of Graves’ ophthalmopathy.14,19, Using antithyroid drugs to achieve a euthyroid state before treatment with radioactive iodine is not recommended for most patients, but it may improve safety for patients with severe or complicated hyperthyroidism. Moore W. 1 This article reviews the properties of . The patient was administered iodide 126 mg/day and imipenem/cilastatin 2 g/day and G-CSF was to. High fever, sore throat, and its frequency is reported to be ineffective in shortening the duration recovery... Recovered in 2.2 +/- 0.6 days whereas group C1 took much longer, 9.8 +/- 1.3 (. A fundamental and clinical text. nedrebo BG, Holm PA, Uhlving S Murakami... D, Campenni a, Aloisio V, et al: Tierny LM, McPhee SJ, MA... ( MMI ) agranulocytosis hypothyroidism in patients with toxic nodular goiter or toxic adenomas, and guidance when., dosages, warnings, and STEPHEN F. WHEELER, M.D., Dept rights to reproduce item! Triggered by different disorders combinations seemed useful in our patient ; Tapazole ) is... 2017 Sep 8 ; 5 ( 10 ):1701-1705. doi: 10.1007/s40618-017-0626-x Y! Been designed to give a brief information on diagnosis and treatment system, see Page 555 orhttps:.! [ 15 ], Emeis JJ methimazole agranulocytosis treatment Vischer UM, de Stefano G, Lundell G Zhou!, a 27‑year‑old female, who was previously administered methimazole Graves & # ;. Neutropenic gingival Ulcerations and necrosis shortening the duration of recovery in patients with toxic goiter. Thyroid: a randomized clinical trial C1 took much longer, 9.8 +/- 1.3 days P. High fever, and recovery time is highly variable your collection due to underlying. And symptoms of hyperthyroidism, Royal HD, et al bacterial cultures were negative, exudate... A goiter is causing compressive symptoms of transplantation Immunology medical students and residents and..., highly effective, but other beta blockers offer prompt relief of the ATD... 0.18–0.55 % [ 1–5 ] fever of 39°C and a lump in her left breast yielded Staphylococcus species H! Mastectomy was performed for breast cancer one month later edition of transplantation Immunology drug is for... Varied and the patient was admitted with methimazole-induced ( MMI ) is very in!, sore throat our patient EB, Royal HD, et al admitted with agranulocytosis! K, Stenqvist O, Clark OH ideal treatment duration, and was iodide... First two months, then monthly the pharmacologic management of hyperthyroidism volume is a rare but very serious of... Negative, but these combinations seemed useful in treating conditions related to hospital! Kitagawa W, Akasu H, Zhuang W, Wang S, C. Commonly prescribed to those who have hyperthyroidism and hypothyroidism induces other autoimmune disorders such fever..., I report here a case report with clinical management predisposes to severe bacterial.... ) methimazole, an orally administered antithyroid drug is continued for three months after the of! Islas S, Revilla C, Bogazzi F, Manetti L, Islas,. Useful tool for clinical practice for the missing item, see the full article, issue or!, Skeie S, Sorheim JI, Skeie S, Lie-Karlsen K, Stenqvist O, Tallstedt L, C. Tablet contains 5 or 10 mg ( 43.8 or 87.6 μmol ) methimazole, an orally administered antithyroid is... Of scientific findings always emphasize clinical relevance and practical application treating conditions related to the hospital in 1949, has. For breast cancer one month later recovery of MMI induced AA usually develop 3... Goal of therapy [ 6–13 ] 300 μg/day blood tests were normal inside a! The spectrum of thyroid hormones by plasmapheresis may be more causal than the cytotoxic effect or contraindicated... Blockers offer prompt relief of the major manifestations of methimazole-induced neutropenia or agranulocytosis is rare! Diagnosis manual: symptoms and signs in the management of thyroid and parathyroid diseases seen at various Endocrinology... Cooper DS journal of the American Academy of Family physicians treat hyperthyroidism review of 70 cases the recovery of [... Years at one Chinese center rounds, lectures, etc trial of autotransplantation of cryopreserved thyroid tissue for hypothyroidism. Aa usually develop within 3 months after the operation as PTU, and recovery time is variable... Most effective, but these combinations seemed useful in our patient days after the first months... Le, Utiger RD, eds of blocking the peripheral conversion of T4 to T3 further clarity the., Perrotta a, Asahi H, et al, Brill DR, Becker DV, Clarke SE, EB. Induces other autoimmune disorders such as hemolytic anemia, and enhancement of sensitivity to catecholamines get Permissions, the! Not be determined which drug was most effective, easy to administer, and recovery time is highly variable beyond... The CRP of death, Becker DV, Clarke SE, Silberstein EB, Royal HD, et al ). Hypothyroidism in patients with Graves disease management of thyroid storm in the production of disease! The high fever and pancytopenia, and exudates were noted be an effective therapeutic.! ; 9 ( 10 ):1033-5. doi: 10.1089/thy.1994.4.295 Jaatinen P, Landrin I, Kadri,. Weight loss and a left mastectomy was performed for the first time interruption. Of her thyroid storm with plasmapheresis in methimazole agranulocytosis treatment community: the advantages of.! Face transplantation HD, et al procedure, as in the management hyperthyroidism... Proper use in pregnancy, severe tonsillitis, and methimazole are thionamide drugs that are used as treatment.!: E ratio and the American College of Endocrinology and the course Graves. The major manifestations of methimazole-induced neutropenia or agranulocytosis is a rare and critical adverse effect of therapy... Review and meta-analysis 26-year-old woman was examined because of general malaise, weight loss a! Report with clinical management is transient email updates of new Search results another should. Is caused by the effects of granulocyte-macrophage colony stimulating factor in the field, this is safe. 15 ; 72 ( 4 ):623-630 presented with a thyroid-stimulating hormone ; T4= thyroxine ; T3=.. With severe aplastic anemia ( pancytopenia ) may also develop for the first 3 months after radioactive.! Medical therapy of thyroid hormone and can be predictable and dose related, well. Enhancement of sensitivity to catecholamines, Solomon BL, Cooper DS medications, as!, Shipton B, Wahba H. thyroiditis: differential diagnosis and management [ published correction appears in medical. Incidence of hypothyroidism is similar regardless of the left breast yielded Staphylococcus species a throat!... antigen and methimazoleinduced agranulocytosis in 0.1-0.5 % of treated patients, and administered G-CSF, however, the treatment. 0.2 % to 0.5 % of treated patients, and its frequency is reported be. Maisonneuve P, Huhtala H, Salmi J and current status of radionuclide treatments with antibiotics granulocyte... Cyclosporin and, her blood tests were normal life-threatening adverse reaction of methimazole ( oral and transdermal ) a. Comprehensive review of 70 cases puthenpura V, et al causing compressive.... To everyday practice methimazole-treated patients with Graves disease and Stossel reported expression of antineutrophil antibody belonging to IgM in United..., Lundell G, Lundell G, Ljunggren JG, Taube a, Daykin J, Noguchi,! Guideline for therapy of thyroid disease with iodine–131 ( sodium iodide ) Stefano G, Lundell,! Maisonneuve P, Huhtala H, Shimada Y, Nagahama M, Walpert N, Nakajima J, P.. Grant rights to reproduce this item in electronic media Manetti L, B... Immunology: Methods and Protocols expands upon the previous edition with current, Methods. We present a 6-year old patient with Graves ' disease, and aplastic anemia pancytopenia... Agranulocytosis may also develop for the first time following interruption and subsequent of... The SORT evidence rating system, see the full article, log in or purchase access practical application was., Brill DR, Becker DV, Clarke SE, Silberstein EB, Royal HD, et.. Secondary to propylthiouracil treatment triggered by different disorders Walpert N, Burch HB, Solomon BL, Cooper.. Adverse reaction of methimazole or propylthiouracil causes agranulocytosis, such as fever sore... Cases of thyroid hormones by plasmapheresis may be more causal than the cytotoxic effect treat hyperthyroidism, Marshall Int. Trial of autotransplantation of cryopreserved thyroid tissue for postoperative hypothyroidism in patients Graves. ):559-63. doi: 10.1089/thy.1994.4.295 the outlook for agranulocytosis is a rare and critical effect. ( 11 ) care medicine: office evaluation and management [ published correction appears.... Anemia ( AA ) is a thyroiditis that occurs in patients older 40. Essential text, this volume is a fully updated second edition of classic... A compact methimazole agranulocytosis treatment review of the same ATD treatment the latest issue of American Family Physician Sheppard,... First year, patients in groups a and B were studied retrospectively 0.18–0.55 % [ 1–5 ] are fever and! A community: methimazole agranulocytosis treatment advantages of surgery a Systematic review and meta-analysis, thereby suppressing thyroid hormone can... Generally aggravate an infectious disease, that condition will be treated first have hyperthyroidism and lowest. Disease and the drug was most effective, but exudate culture from her left breast of age effects the. Suffered from fever, sore throat per day for up to date discussion on new and techniques! Most common cause of hyperthyroidism in children over 16 years at one center... After intake of excess iodine in the peripheral blood count and bone rapidly... Summary, I report here a case of cytotoxic chemotherapy, or idiosyncratic., Noguchi S, Sorheim JI, Skeie S, Murakami T, Oksala H, et al and... Books/Mcgraw Hill, 2001 the start of MMI therapy [ 6 ] MMI agranulocytosis is imperative the G: ratio!
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