methimazole and Neutropenia

A woman in her 30s presented to the emergency department with new-onset sore throat and fever. She had recently been diagnosed with Graves' disease 3 months prior. As a result, she was initiated on atenolol and methimazole for management. Her methimazole dosing had been stable at 15 mg daily for the month prior to presentation. Investigation revealed severe neutropenia and jaundice. She was found to have concomitant agranulocytosis and cholestatic jaundice secondary to methimazole.Methimazole was discontinued on admission and the patient received granulocyte colony-stimulating factor for an absolute neutrophil count (ANC) of zero. She was placed on broad-spectrum antibiotics and intravenous steroids for epiglottic and supraglottic oedema noted on bedside laryngoscopy. ANC and bilirubin improved over a 2-week hospital course. She was discharged on a temporary regimen of propranolol, dexamethasone and potassium iodide until she was able to undergo successful thyroidectomy for definitive management of Graves' disease outpatient.

Topics: Agranulocytosis; Antithyroid Agents; Female; Graves Disease; Humans; Jaundice, Obstructive; Methimazole; Neutropenia

To investigate the incidence rate of adverse reactions of methimazole in children with hyperthyroidism.. A retrospective analysis was performed on the medical data of 304 children with hyperthyroidism who were hospitalized in Shengjing Hospital of China Medical University from January 2015 to May 2021. The incidence rate of methimazole-related adverse reactions was analyzed. The risk factors for common adverse reactions were evaluated.. Among the 304 children, 87 (28.6%) experienced adverse reactions, among whom there were 20 boys (23%) and 67 girls (77%). Common adverse reactions included neutropenia (12.8%), rash (11.8%), elevated alanine aminotransferase (9.5%), and joint pain (3.0%), and some children experienced multiple adverse reactions simultaneously or intermittently. Neutropenia often occurred within 3 months after administration (25/39, 64%), elevated alanine aminotransferase often occurred within 1 month after administration (17/29, 59%), and rash often occurred within 3 months after administration (30/36, 83%). Most of the above adverse reactions returned to normal after symptomatic treatment. The multivariate logistic regression analysis showed that younger age and lower absolute neutrophil count before treatment were risk factors for neutropenia after methimazole treatment (. The adverse reactions of methimazole are common in children with hyperthyroidism, and most adverse reactions occur within 3 months after administration and can be relieved after symptomatic treatment. Children with a younger age or a lower baseline absolute neutrophil count may have a higher risk of neutropenia.

Topics: Alanine Transaminase; Antithyroid Agents; Child; Exanthema; Female; Humans; Hyperthyroidism; Male; Methimazole; Neutropenia; Retrospective Studies

The treatment of Graves' hyperthyroidism (GD) complicated with malignancy is challenging, as anti-thyroid thionamide drugs (ATDs) and anti-cancer chemotherapy are both associated with a risk of neutropenia. Treatment with conventional ATDs, radioactive iodine (RAI) or potassium iodide (KI) was attempted in 8 patients with malignancy (34-80 years of age; 2 males and 6 females) in whom GD had been fortuitously diagnosed during a detailed systematic examination. Three patients requiring surgery were initially treated conventionally with methylmercaptoimidazole (MMI), MMI and KI or RAI (group A; one patient each). The patients became euthyroid on days 17-31 and underwent surgery on days 25-47. RAI therapy was administered to one patient after surgery. The patients were then treated with KI during chemotherapy. Five other patients who did not require surgery were initially treated with 100 mg KI monotherapy (group B). The serum free T

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Antithyroid Agents; Female; Graves Disease; Humans; Hyperthyroidism; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Neoplasms; Neutropenia; Potassium Iodide; Risk Factors; Thyroidectomy

Agranulocytosis is known to be a rare side effect of thionamides. This complication puts pregnant patients at particular risk for infections. Obstetricians caring for such patients have the difficult task of deciding between conservative or surgical management.. The patient is a 37-year-old gravida 4 para 3 Hispanic woman at 11 weeks of gestation with recently diagnosed hyperthyroidism who presented with a neutropenic fever and ecthyma as a complication of thionamide use. She subsequently underwent a thyroidectomy and then had a spontaneous abortion on postoperative day 2.. This patient had life-threatening thyrotoxicosis complicated by neutropenic fever and infection, likely caused by a reaction to thionamides. She quickly recovered with broad-spectrum antibiotics. She could not be restarted on methimazole or propylthiouracil as a result of agranulocytosis and thus underwent thyroidectomy.

Topics: Adrenergic beta-1 Receptor Antagonists; Adult; Antithyroid Agents; Atenolol; Drug Eruptions; Ecthyma; Female; Humans; Hyperthyroidism; Methimazole; Neutropenia; Pregnancy; Pregnancy Complications; Propylthiouracil; Staphylococcal Skin Infections; Staphylococcus aureus

A 48-year old woman with a recent diagnosis of Graves' disease arrived at the emergency room with fever, palpitations, and a sore throat. Her regular treatment included methimazole. On admission, laboratory results showed suppressed TSH, elevated free thyroxine, and neutropenia. She was admitted and started on antibiotics and granulocyte-macrophage colony stimulating factor (gm-csf). After ten days, the patient developed leukocytosis, fever, and hemoptysis. Chest CT scan showed a lung cavity with multiple nodules in the upper right lobe. Cultures from a lung biopsy were positive for Aspergillus Fumigatus and Aspergillus Flavus. Amphotericin B was started but then switched to voriconazole, with both treatments failing to result in clinical improvement. The patient died of multi-organ failure.

Topics: Antithyroid Agents; Female; Humans; Methimazole; Middle Aged; Neutropenia; Pulmonary Aspergillosis

Antithyroid drugs (ATDs) are prescribed as the initial therapy for the majority of patients with Graves' disease in many areas of the world. Although, it is well known that agranulocytosis is one of the most serious side effects of ATDs, there has not yet been any conclusive evidence that the prevalence of agranulocytosis induced by ATDs is dose related. This study was performed to determine if the prevalence of agranulocytosis is different depending on the starting dosage of ATDs in patients with Graves' disease.. Until 1996, we had typically prescribed 30 mg/d of methimazole (MMI) as the initial dosage for the treatment of Graves' disease at our institution. We changed the initial MMI dosage to 15 mg/d as a general rule in 1997. As a consequence, we acquired two groups of patients with Graves' disease who received different dosages of MMI. We retrospectively compared the prevalence of MMI-induced agranulocytosis in patients who received 15 mg/d of MMI to those who received 30 mg/d of MMI.. There were 2087 subjects treated with 30 mg/d of MMI and 2739 treated with 15 mg/d of MMI. The prevalence of agranulocytosis in the 30 mg/d group was significantly higher than in the 15 mg/d group (0.814% vs. 0.219%, respectively, p < 0.01). The prevalence of agranulocytosis plus neutropenia in the 30 mg/d group was also significantly higher than in the 15 mg/d group (1.581% vs. 0.474%, respectively, p < 0.001).. It is very likely that MMI-induced agranulocytosis occurs with a larger dosage of MMI and is dose related. Considering both the effectiveness and the risk of serious side effects, we recommend 15 mg/d of MMI as the starting dosage for the treatment of Graves' disease.

Topics: Adolescent; Adult; Agranulocytosis; Antithyroid Agents; Dose-Response Relationship, Drug; Female; Graves Disease; Humans; Leukocyte Count; Male; Methimazole; Middle Aged; Neutropenia; Neutrophils; Retrospective Studies; Young Adult

Topics: Adult; Antithyroid Agents; Female; Fever; Filgrastim; Granulocyte Colony-Stimulating Factor; Graves Disease; Humans; Injections, Subcutaneous; Methimazole; Neutropenia; Recombinant Proteins

Neutropenic colitis, characterized by neutropenia plus cecal and ascending colon inflammation, is a rare complication of chemotherapy in hematological malignancies and, less commonly, of medication used to treat other diseases (e.g., hyperthyroidism). We report a case of neutropenic colitis with cecal perforation in a 44-year-old woman treated with methimazole for hyperthyroidism. The patient had received subtotal thyroidectomy for hyperthyroidism in 1984 and recurrent hyperthyroidism was found in 1993. She was then treated with methimazole for almost 3 months, when sustained fever, diarrhea, weakness, and progressive abdominal pain developed. Due to the findings of peritonitis and neutropenia, she underwent emergent laparotomy. During the operation, chronic ulceration of the cecum with perforation was found and resection of the ileocecal segment and ileostomy were performed. Three months later, closure of the ileostomy with anastomosis of the ileocolostomy was performed. Her condition was stable during 9 years' follow-up. In conclusion, neutropenic enterocolitis has a broad spectrum of clinical presentations that require alertness in patients with neutropenia. When detected late, it may lead to bowel perforation and even mortality.

Topics: Adult; Antithyroid Agents; Cecal Diseases; Colitis; Female; Humans; Hyperthyroidism; Intestinal Perforation; Methimazole; Neutropenia

Ms. K., a white, 47-year-old female with a history of hyperthyroidism had been treated with methimazole daily for a period of 9 years. She presented with a 2-day history of fever higher than 103 degrees F and cellulitis of the right arm after a scratch injury. White blood cell count (WBC) was noted at 0.4 x 10(3)/microL and neutrophils at 5.6%, indicating agranulocytosis. Methimazole was discontinued by the patient with the onset of symptoms. Appropriate intravenous antibiotic therapy and reverse isolation were provided in the acute-care setting, as well as administration of the granulocyte colony-stimulating factor (G-CSF) filgrastim. No recovery of the granulocyte count or improvement of clinical condition was noted until her sixth day of admission, at which time her WBC increased to 2.6 x 10(3)/microL. The administration of intravenous antifungals and antibiotics prevented overwhelming sepsis, while giving the G-CSF the opportunity to stimulate growth of granulocytes to finally fight the offending organisms and save this patient.

Topics: Antithyroid Agents; Female; Humans; Hyperthyroidism; Infection Control; Leukocyte Count; Methimazole; Middle Aged; Neutropenia; Nurse Practitioners

Antineutrophil antibody capable of opsonising normal neutrophils was detected in the sera of 16 neutropenic patients receiving various drugs. A single drug was involved in 10 cases, multiple medication in 6. 4 patients received semisynthetic penicillins, 8 some form of antimicrobial, and 2 antithyroid agents. Neutrophil counts rose, and antineutrophil antibody activity declined or disappeared, after drug therapy was stopped. Opsonisation related to the semisynthetic penicillins was independent of complement but dependent on drug concentration. Complement-dependent opsonic activity was demonstrated in 2 patients (1 receiving methimazole and 1 receiving multiple medication) and in the patient receiving methimazole this activity was shown to reside in the IgM serum-fraction. In another patient receiving multiple drugs, a complement-independent IgG antibody was demonstrated.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Chlorothiazide; Chlorpromazine; Complement C3; Drug Hypersensitivity; Drug Therapy, Combination; Female; Humans; Immunoglobulin G; Immunoglobulin M; Male; Methimazole; Middle Aged; Neutropenia; Neutrophils; Opsonin Proteins; Penicillins; Quinidine