CASE REPORT: PDF OnlyAntithyroid Drug-induced AgranulocytosisSun, Ming-Tsunga, c; Tsai, Chen-Haob, c; Shih, Kuang-Chungc, * Author Information aDepartment of Internal Medicine, Hualien Armed Forces General Hospital, Hualien, Taipei, Taiwan, R.O.C. bDepartment of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taipei, Taiwan, R.O.C. cDivision of Endocrinology and Metabolism, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C. *Correspondence to: Dr Kuang-Chung Shih, Division of Endocrinology and Metabolism, Tri-Service General Hospital, 325, Section 2, Cheng-Kung Road, Neihu, Taipei 114, Taiwan, R.O.C. E-mail: [email protected] Received: December 24, 2008; • Accepted: May 11, 2009. Journal of the Chinese Medical Association: August 2009 - Volume 72 - Issue 8 - p 438-441 doi: 10.1016/S1726-4901(09)70402-2 Metrics Abstract Antithyroid drugs are widely used to treat hyperthyroidism, especially Graves' disease, but they tend to cause agranulocytosis, which increases the mortality rate. Granulocyte colony-stimulating factor decreases the duration of recovery from agranulocytosis. We retrospectively studied cases of antithyroid drug-induced agranulocytosis over the past 10 years in a northern Taiwan medical center. A clinical evaluation was conducted, including a review of complete blood cell counts and differential counts. Four cases were included in this analysis. Agranulocytosis persisted in 2 cases despite a change in therapy from propylthiouracil to methimazole. Fever, sore throat, and diarrhea were common symptoms of agranulocytosis. Initial white blood cell counts ranged from 450 to 1,710/μL. Only 1 case had a positive result from a throat swab culture (Staphylococcus aureus). Three of 4 cases received granulocyte colony-stimulating factor therapy, and the recovery time ranged from 3 to 13 days. All of the patients recovered from agranulocytosis. We concluded that: (1) conducting a routine complete blood cell count is beneficial in alerting caregivers to the possibility of agranulocytosis; (2) educating patients about the common symptoms of agranulocytosis may contribute to an early diagnosis; (3) providing granulocyte colony-stimulating factor therapy to patients results in good prognosis; and (4) monitoring for cross-reactions between drugs should be performed to prevent further episodes of agranulocytosis. © 2009 by Lippincott Williams & Wilkins, Inc.