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Article

Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study

by
Carlos García Gómez
1,2,*,
Elena Navarro
3,
Victoria Alcázar
4,
Antonio López-Guzmán
5,
Francisco Arrieta
6,
Emma Anda
7,
Betina Biagetti
8,
Fernando Guerrero-Pérez
9,
Carles Villabona
9,
Andrés Ruiz de Assín Valverde
10,
Cristina Lamas
10,
Beatriz Lecumberri
11,
José Antonio Rosado Sierra
12,
Julia Sastre
13,
Juan José Díez
1,2 and
Pedro Iglesias
1,2
1
Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), 28222 Madrid, Spain
2
Department of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
3
Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
4
Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, 28914 Madrid, Spain
5
Department of Endocrinology and Nutrition, Complejo Asistencial de Ávila, 05004 Ávila, Spain
6
Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
7
Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
8
Department of Endocrinology and Nutrition, Hospital Universitari Vall d’Hebrón, 08035 Barcelona, Spain
9
Department of Endocrinology and Nutrition, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
10
Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Albacete, 02008 Albacete, Spain
11
Department of Endocrinology and Nutrition, Hospital Universitario La Paz, 28046 Madrid, Spain
12
Department of Endocrinology and Nutrition, Hospital Universitario Getafe, 28905 Madrid, Spain
13
Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Toledo, 45007 Toledo, Spain
 
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*
Author to whom correspondence should be addressed.
J. Clin. Med. 2023, 12(20), 6556; https://doi.org/10.3390/jcm12206556
Submission received: 13 September 2023 / Revised: 8 October 2023 / Accepted: 10 October 2023 / Published: 16 October 2023
(This article belongs to the Special Issue Advances in Thyroid Diseases: Focus on Hypothyroidism and Hyperthyroidism)
Versions Notes

Abstract

Background: Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/µL) is a rare but serious complication in the treatment of hyperthyroidism. Methodology: Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves’ disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. Results: The median (IQR) time to development of agranulocytosis was 6.0 (4.0–11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves’ disease), and two patients died of septic shock secondary to AIA. Conclusions: AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously.
Keywords: antithyroid drug-induced agranulocytosis (AIA); carbimazole (CBZ); methimazole (MMI); propylthiouracil (PTU) antithyroid drug-induced agranulocytosis (AIA); carbimazole (CBZ); methimazole (MMI); propylthiouracil (PTU)

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MDPI and ACS Style

García Gómez, C.; Navarro, E.; Alcázar, V.; López-Guzmán, A.; Arrieta, F.; Anda, E.; Biagetti, B.; Guerrero-Pérez, F.; Villabona, C.; de Assín Valverde, A.R.; et al. Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study. J. Clin. Med. 2023, 12, 6556. https://doi.org/10.3390/jcm12206556

AMA Style

García Gómez C, Navarro E, Alcázar V, López-Guzmán A, Arrieta F, Anda E, Biagetti B, Guerrero-Pérez F, Villabona C, de Assín Valverde AR, et al. Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study. Journal of Clinical Medicine. 2023; 12(20):6556. https://doi.org/10.3390/jcm12206556

Chicago/Turabian Style

García Gómez, Carlos, Elena Navarro, Victoria Alcázar, Antonio López-Guzmán, Francisco Arrieta, Emma Anda, Betina Biagetti, Fernando Guerrero-Pérez, Carles Villabona, Andrés Ruiz de Assín Valverde, and et al. 2023. "Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study" Journal of Clinical Medicine 12, no. 20: 6556. https://doi.org/10.3390/jcm12206556

APA Style

García Gómez, C., Navarro, E., Alcázar, V., López-Guzmán, A., Arrieta, F., Anda, E., Biagetti, B., Guerrero-Pérez, F., Villabona, C., de Assín Valverde, A. R., Lamas, C., Lecumberri, B., Rosado Sierra, J. A., Sastre, J., Díez, J. J., & Iglesias, P. (2023). Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study. Journal of Clinical Medicine, 12(20), 6556. https://doi.org/10.3390/jcm12206556

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