Nakamura Hirotoshi, Ide Akane, Kudo Takumi, Nishihara Eijun, Ito Mitsuru, Miyauchi Akira
Kuma Hospital, Kobe, Japan.
Eur Thyroid J. 2016 Dec;5(4):253-260. doi: 10.1159/000448586. Epub 2016 Sep 6.
Finding agranulocytosis (AG) at an early stage is important to improve outcome, but periodic granulocyte count monitoring is not generally recommended for patients with Graves' disease, because AG develops suddenly.
At the Kuma Hospital, Graves' patients under antithyroid drug (ATD) treatment in an outpatient clinic have a granulocyte count examination during each visit, and if it is <1,000/μl, a warning is immediately sent to the patient's physician. We evaluated the usefulness of this system.
We investigated 25 AG and 33 granulocytopenia (GP) cases over a recent 5-year period, excluding patients who developed AG or GP at another hospital and were referred to us for treatment. Among the 25 AG patients, 16 patients (64%; 9 asymptomatic and 7 very mild symptomatic cases) were discovered by the periodic granulocyte count examination at an outpatient clinic. The remaining 9 patients visited the Kuma Hospital or other hospitals because of infection symptoms. Most of the AG patients were given granulocyte colony-stimulating factor injections immediately and were admitted if a prompt increase in granulocytes could not be obtained. The final treatments for Graves' disease were I-radioisotope therapy (19 patients), thyroidectomy (2 patients), inorganic iodine (1 patient), or another ATD (1 patient). Among the 33 GP patients, 31 (94%), including 20 asymptomatic cases, were discovered during periodic granulocyte count monitoring. Most of them stopped ATD, and other treatments for Graves' disease were selected.
Periodic monitoring of granulocyte counts is useful for identifying AG and GP patients with no or minimum infection symptoms.
早期发现粒细胞缺乏症（AG）对于改善预后很重要，但由于AG发病突然，一般不建议对格雷夫斯病患者进行定期粒细胞计数监测。
在久留米医院，门诊接受抗甲状腺药物（ATD）治疗的格雷夫斯病患者每次就诊时都要进行粒细胞计数检查，如果计数<1000/μl，会立即向患者的医生发出警告。我们评估了该系统的实用性。
我们调查了最近5年期间的25例AG和33例粒细胞减少症（GP）病例，排除了在其他医院发生AG或GP并转诊至我院治疗的患者。在25例AG患者中，16例（64%；9例无症状，7例症状非常轻微）通过门诊定期粒细胞计数检查发现。其余9例患者因感染症状就诊于久留米医院或其他医院。大多数AG患者立即接受了粒细胞集落刺激因子注射，如果粒细胞未能迅速增加则入院治疗。格雷夫斯病的最终治疗方法为碘-131放射性核素治疗（19例）、甲状腺切除术（2例）、无机碘（1例）或另一种ATD（1例）。在33例GP患者中，31例（94%），包括20例无症状病例，在定期粒细胞计数监测期间被发现。他们中的大多数停止了ATD治疗，并选择了格雷夫斯病的其他治疗方法。
定期监测粒细胞计数有助于识别无感染症状或感染症状轻微的AG和GP患者。
