Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
Endocr Pract. 2010 Jul-Aug;16(4):673-6. doi: 10.4158/EP09265.CR.
To report a case of a patient with Graves disease presenting with agranulocytosis induced by methimazole, with subsequent thyroid storm and successful therapeutic use of plasmapheresis.
The clinical features and laboratory findings in a patient with agranulocytosis and thyroid storm are presented, and the available literature on utilization of plasmapheresis in the setting of thyrotoxicosis is reviewed.
A 40-year-old Vietnamese woman with Graves disease was admitted with methimazole-induced agranulocytosis. Treatment with methimazole was discontinued, and therapy with antibiotics, granulocyte colony-stimulating factor, and ibuprofen was initiated. During hospitalization of the patient, her clinical status deteriorated, with development of pericarditis, thrombocytopenia, and thyroid storm. Treatment with plasmapheresis yielded near-euthyroidism in 3 days. Subsequently, she underwent successful total thyroidectomy.
Our case highlights the effectiveness of plasmapheresis when clinical situations prohibit the use of traditional treatment methods for thyrotoxicosis or thyroid storm (or both).
报告 1 例由甲巯咪唑引起的格雷夫斯病（Graves disease）患者伴发中性粒细胞减少症、继而出现甲状腺危象，并成功应用血浆置换治疗的病例。
本文呈现了 1 例中性粒细胞减少症伴甲状腺危象患者的临床特征和实验室检查结果，并对甲状腺毒症患者应用血浆置换治疗的相关文献进行了回顾。
1 例 40 岁越南裔女性，患有格雷夫斯病，因甲巯咪唑引起的中性粒细胞减少症而入院。停用甲巯咪唑，给予抗生素、粒细胞集落刺激因子和布洛芬治疗。住院期间，患者病情恶化，出现心包炎、血小板减少和甲状腺危象。3 天后，行血浆置换治疗后患者接近甲状腺功能正常。随后，她成功接受了甲状腺全切除术。
本病例强调了在某些临床情况下（当传统的治疗方法治疗甲状腺毒症或甲状腺危象（或两者同时存在）受到限制时），血浆置换治疗的有效性。
