Characteristics of antithyroid drug-induced agranulocytosis in patients with hyperthyroidism: A retrospective analysis of 114 cases in a single institution in China involving 9690 patients referred for radioiodine treatment over 15 years.

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Characteristics of antithyroid drug-induced agranulocytosis in patients with hyperthyroidism: A retrospective analysis of 114 cases in a single institution in China involving 9690 patients referred for radioiodine treatment over 15 years.

Thyroid. 2016 Feb 11;

Authors: Yang J, Zhu YJ, Zhong J, Zhang J, Weng WW, Liu Z, Xu Q, Dong M

Abstract
BACKGROUND: Antithyroid drug (ATD)-induced agranulocytosis is a rare but life-threatening disease. Clinical features of ATD-induced agranulocytosis and outcomes remain incompletely understood.
METHOD: We retrospectively studied patients with clinically diagnosed ATD-induced agranulocytosis involving 9690 patients who were referred for radioiodine treatment during a 15-year period (2000-2015) in China. Finally, there were 114 cases of agranulocytosis attributable to ATD included and their clinical characteristics and therapy outcomes were analyzed.
RESULTS: The female to male ratio of ATD-induced agranulocytosis was 10.4:1. The mean age of the patients with ATD-induced agranulocytosis was 41.7 ± 12.3 years (mean ± standard deviation). The methimazole (MMI) and propylthiouracil (PTU) dose given at the onset were 22.9 ± 8.0 mg/day and 253.6 ± 177.5 mg/day, respectively. ATD-induced agranulocytosis occurred in 45.1%, 74.3% and 88.5% of patients within 4, 8, and 12 weeks of the onset of ATD therapy, respectively. Fever (78.9%) and sore throat (72.8%) were the most common symptoms when agranulocytosis was diagnosed. The mean recovery time of agranulocytosis was 13.41 ± 7.14 days. Recovery time in the G-CSF-treated group (12.7 ± 6.0 days) did not differ from that in the group not treated with G-CSF (16.4 ± 10.6 days) (p = 0.144). Treatment of 131I was successful in 87 out of the 98 patients (88.8%). The success rate of 131I was equivalent (p = 1.000) between the groups receiving MMI (88.2%, 75/85) and PTU (92.3%, 12/13).
CONCLUSIONS: This largest single institution study in China shows that ATD-induced agranulocytosis tends to occur within the first 12 weeks after the onset of ATD therapy. For patient with ATD-induced agranulocytosis, G-CSF does not improve recovery time of agranulocytosis and 131I is an optimal treatment approach.

PMID: 26867063 [PubMed - as supplied by publisher]

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