Shale Wongel Tena, Umer Keno Mohammed, Tola Gutu Ganati, Guluju Fayera Abetu
Jimma University, College of Public Health and Medical Sciences, Department of Surgery, Jimma, Oromia, Ethiopia.
Department of General Surgery, Dire Dawa University, Dire Dawa, Ethiopia.
Int Med Case Rep J. 2023 Sep 6;16:503-512. doi: 10.2147/IMCRJ.S424053. eCollection 2023.
Agranulocytosis is a rare but fatal side effect of antithyroid drugs (ATDs) with incidence reported at 0.1%-1%. Agranulocytosis is defined as a granulocyte count <500 cells/μL following the use of ATDs and is an absolute contraindication to the use of these drugs; in this case, radioactive iodine (RAI) or surgery are therapeutic options.
A 28-year-old female patient was on follow-up at our clinic after she presented with anterior neck swelling of 4 years. The patient was started on propylthiouracil (PTU) and propranolol based on clinical symptoms of hyperthyroidism and low thyroid stimulating hormone (TSH) levels. After taking the ATDs for 7 months, she came to the clinic for her regular follow-up. At this point, she was declared euthyroid and booked for surgery. Investigations were sent and the complete blood count (CBC) result showed leucopenia with agranulocytosis, even though she was completely asymptomatic. The offending ATD was immediately discontinued. The patient was kept inpatient for monitoring, and lugol's iodine and propranolol were initiated. Eight days after discontinuing the ATD, the CBC profile was determined once again, showing normalized total leukocyte, as well as, absolute neutrophil count. Eventually, the multinodular goiter (MNG) was managed with subtotal thyroidectomy.
Despite the fact that agranulocytosis is an extremely rare side effect of ATDs, most often PTU; it is a potentially fatal complication when it occurs. Patient education at the time of prescription should not be overlooked, and systematic programs should be put in place. The baseline granulocyte count should be determined and monitored on a regular basis.
粒细胞缺乏症是抗甲状腺药物（ATD）罕见但致命的副作用，报告发生率为0.1%-1%。粒细胞缺乏症定义为使用ATD后粒细胞计数<500个细胞/μL，是使用这些药物的绝对禁忌证；在这种情况下，放射性碘（RAI）或手术是治疗选择。
一名28岁女性患者因颈部前方肿胀4年前来我院门诊随访。根据甲状腺功能亢进的临床症状和低促甲状腺激素（TSH）水平，患者开始服用丙硫氧嘧啶（PTU）和普萘洛尔。服用ATD 7个月后，她前来门诊进行常规随访。此时，她被判定甲状腺功能正常，并预约了手术。进行了相关检查，全血细胞计数（CBC）结果显示白细胞减少伴粒细胞缺乏症，尽管她完全没有症状。立即停用了引起问题的ATD。患者住院监测，并开始使用卢戈氏碘和普萘洛尔。停用ATD 8天后，再次测定CBC，结果显示总白细胞和绝对中性粒细胞计数恢复正常。最终，通过甲状腺次全切除术治疗了多结节性甲状腺肿（MNG）。
尽管粒细胞缺乏症是ATD极其罕见的副作用，最常见于PTU；但一旦发生，它是一种潜在致命的并发症。处方时的患者教育不应被忽视，应制定系统的方案。应定期测定并监测基线粒细胞计数。
