Finucane F M, O'Connell J, Kinsley B T
Department of Endocrinology and Diabetes Mellitus, Mater Misericordiae Hospital, Eccles' Street, Dublin 7, Ireland.
Ir J Med Sci. 2008 Mar;177(1):69-71. doi: 10.1007/s11845-007-0055-5. Epub 2007 Jul 5.
Thionamide induced agranulocytosis is associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA) in some patients. This poses a particular challenge when it occurs during pregnancy.
To report a case of a 31-year-old woman with Graves' disease who presented at 11 weeks gestation with propylthiouracil induced agranulocytosis.
After cessation of propylthiouracil the patient developed recurrent thyrotoxicosis, and underwent an elective subtotal thyroidectomy at 23 weeks gestation.
The patient required postoperative thyroxine replacement therapy. Subsequent pregnancy was uneventful and she delivered a healthy baby boy at 41 weeks gestation. As part of our routine work up for agranulocytosis we measured C-ANCA levels, which were significantly elevated.
This case highlights the association of propylthiouracil induced ANCA positivity and agranulocytosis. Second trimester subtotal thyroidectomy was safe and effective in treating this pregnant patient's thyrotoxicosis.
在一些患者中，硫代酰胺诱发的粒细胞缺乏症与抗中性粒细胞胞浆抗体（ANCA）的存在有关。当这种情况发生在妊娠期时，会带来特殊的挑战。
报告一例31岁患有格雷夫斯病的女性病例，该患者在妊娠11周时出现丙硫氧嘧啶诱发的粒细胞缺乏症。
停用丙硫氧嘧啶后，患者出现反复甲状腺毒症，并在妊娠23周时接受了择期甲状腺次全切除术。
患者术后需要甲状腺素替代治疗。随后的妊娠过程顺利，她在妊娠41周时产下一名健康男婴。作为我们对粒细胞缺乏症常规检查的一部分，我们检测了C-ANCA水平，其显著升高。
该病例突出了丙硫氧嘧啶诱发的ANCA阳性与粒细胞缺乏症之间的关联。孕中期甲状腺次全切除术对于治疗该妊娠患者的甲状腺毒症是安全有效的。
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