Rabelo Patrícia Novais, Rabelo Paula Novais, Paula Allyne Fernanda de, Conceição Samuel Amanso da, Viggiano Daniela Pultrini Pereira de Oliveira, Antunes Daniela Espíndola, Jatene Estela Muszkat, Paula Sílvia Leda França Moura de, Dias Monike Lourenço, Reis Maria Aparecida Lopes
Division of Endocrinology & Metabolism, Intern Medicine Department, Hospital das Clínicas, Faculty of Medicine, Federal University of Goiás (HC-UFG), Goiás, GO, Brasil.
Faculty of Nutrition. Federal University of Goiás (HC-UFG), Goiás, GO, Brasil.
Rev Assoc Med Bras (1992). 2019 Jul 22;65(6):755-760. doi: 10.1590/1806-9282.65.6.755.
Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism. Antithyroid drugs (ATDs) are available as therapy. Agranulocytosis is a rare but potentially fatal complication of this therapy. In this study, we report agranulocytosis induced by propylthiouracil (PTU) in a patient with GD and the difficulties of clinical management.
RNBA, male, 30 years old, with GD, treated with propylthiouracil (PTU). He progressed with pharyngotonsillitis. Then, PTU was suspended and antibiotic, filgrastim, propranolol, and prednisone were initiated. Due to the decompensation of hyperthyroidism, lithium carbonate, dexamethasone, and Lugol's solution were introduced. Total thyroidectomy (TT) was performed with satisfactory postoperative progression.
We describe here the case of a young male patient with GD. For the treatment of hyperthyroidism, thioamides are effective options. Agranulocytosis induced by ATDs is a rare complication defined as the occurrence of a granulocyte count <500/mm3 after the use of ATDs. PTU was suspended, and filgrastim and antibiotics were prescribed. Radioiodine (RAI) or surgery are therapeutic alternatives. Due to problems with ATD use, a total thyroidectomy was proposed. The preoperative preparation was performed with beta-blocker, glucocorticoid, lithium carbonate, and Lugol solution. Cholestyramine is also an option for controlling hyperthyroidism. TT was performed without postoperative complications.
Thionamide-induced agranulocytosis is a rare complication. With a contraindication to ATDs, RAI and surgery are definitive therapeutic options in GD. Beta-blockers, glucocorticoids, lithium carbonate, iodine, and cholestyramine may be an adjunctive therapy for hyperthyroidism.
格雷夫斯病（GD）是一种以甲状腺功能亢进为特征的自身免疫性疾病。抗甲状腺药物（ATD）可作为治疗手段。粒细胞缺乏症是这种治疗的一种罕见但可能致命的并发症。在本研究中，我们报告了1例GD患者丙硫氧嘧啶（PTU）诱发的粒细胞缺乏症及临床管理的困难。
RNBA，男性，30岁，患有GD，接受丙硫氧嘧啶（PTU）治疗。他出现了咽扁桃体炎。随后，停用PTU，并开始使用抗生素、非格司亭、普萘洛尔和泼尼松。由于甲状腺功能亢进失代偿，加用了碳酸锂、地塞米松和卢戈氏溶液。进行了全甲状腺切除术（TT），术后病情进展良好。
我们在此描述1例年轻男性GD患者的病例。对于甲状腺功能亢进的治疗，硫酰胺类药物是有效的选择。ATD诱发的粒细胞缺乏症是一种罕见并发症，定义为使用ATD后粒细胞计数<500/mm³。停用PTU，并开具了非格司亭和抗生素。放射性碘（RAI）或手术是治疗选择。由于使用ATD存在问题，建议进行全甲状腺切除术。术前使用β受体阻滞剂、糖皮质激素、碳酸锂和卢戈氏溶液进行准备。考来烯胺也是控制甲状腺功能亢进的一种选择。进行了TT，术后无并发症。
硫酰胺类药物诱发的粒细胞缺乏症是一种罕见并发症。对于有ATD禁忌证的患者，RAI和手术是GD的确定性治疗选择。β受体阻滞剂、糖皮质激素、碳酸锂、碘和考来烯胺可能是甲状腺功能亢进的辅助治疗药物。
