1
|
Zhou Q, Zhang LY, Fu QX, Zou CC, Liu H. Sepsis-induced Pancytopenia in an Adolescent Girl with Thyroid Storm: A Case Report. J Clin Res Pediatr Endocrinol 2024; 16:367-371. [PMID: 37074093 DOI: 10.4274/jcrpe.galenos.2023.2022-10-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Thyroid storm is a rare but life-threatening condition mainly triggered by infection and abrupt discontinuation of antithyroid drug therapy for Graves’ disease. Pancytopenia is a rare adverse reaction to antithyroid drugs. We present a 13-year-old girl with thyroid storm and pancytopenia with symptoms similar to those of methimazole-induced pancytopenia. Although in this context the use of methimazole is still under debate, due to multiple normal complete blood counts (CBC) monitored during fever, sepsis-induced pancytopenia with thyroid storm was considered, and methimazole treatment combined with methylprednisolone and meropenem was able to resolve both pancytopenia and thyroid storm. During the period of infection and antithyroid drug therapy, close monitoring of CBC may help differentiate the aetiology of pancytopenia. This is the first paediatric case report that outlines the use of methimazole in the management of thyroid storm with pancytopenia.
Collapse
Affiliation(s)
- Qing Zhou
- Fujian Maternity and Child Health Hospital, Clinic of Endocrinology, Fuzhou, China
- Fujian Children’s Hospital, Clinic of Endocrinology, Fuzhou, China
| | - Li-Yong Zhang
- Fujian Medical University Union Hospital, Minimal Invasive Center, Clinic of Thyroid and Vascular Surgery, Fuzhou, China
| | - Qing-Xian Fu
- Fujian Children’s Hospital, Clinic of Endocrinology, Fuzhou, China
| | - Chao-Chun Zou
- Children’s Hospital of Zhejiang University School of Medicine, Clinic of Endocrinology, Hangzhou, China
| | - Hui Liu
- Fujian Maternity and Child Health Hospital, Clinic of Endocrinology, Fuzhou, China
- Fujian Children’s Hospital, Clinic of Endocrinology, Fuzhou, China
| |
Collapse
|
2
|
Sabra MK, Joudeh A, Al Niserat M, Hammamy R. A young patient with Graves' disease presenting with a triad of heart failure, pancytopenia, and jaundice: A case report. Clin Case Rep 2024; 12:e8698. [PMID: 38681046 PMCID: PMC11043085 DOI: 10.1002/ccr3.8698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 05/01/2024] Open
Abstract
Key Clinical Message Graves's disease must be treated promptly to avoid serious sequelae such as cardiomyopathy, liver injury, and pancytopenia. Early initiation of antithyroid medications and beta blockers could not be overrated even in the presence of these complications. Abstract Graves' disease causes a large spectrum of clinical manifestations. Delayed diagnosis and management of Graves' disease could lead to serious systemic sequelae. We describe a case of a young man who presented with progressive cough, increased abdominal girth and ankle swelling for a few months. On examination, he had jaundice, bilateral exophthalmos, diffuse goiter, ascites, and significant lower limb edema. Laboratory investigations showed increased Thyroxin level with a suppressed thyroid stimulating hormone and positive anti-thyrotropin receptor antibodies. Also, the patient had pancytopenia, coagulopathy and cholestatic pattern of elevated liver enzymes. Echocardiography demonstrated mildly reduced left ventricular function with diastolic dysfunction, but electrocardiogram did not show atrial fibrillation. Despite the concerns about using antithyroid medications in patients with impaired liver function tests and pancytopenia, the patient improved dramatically without worsening of his hematological or biochemical parameters. Early initiation of antithyroid medications and beta blockers is essential for patients who are newly diagnosed with hyperthyroidism.
Collapse
Affiliation(s)
- Mohamed Kamal Sabra
- Department of Internal MedicineAl‐Khor Hospital, Hamad Medical CorporationDohaQatar
| | - Anwar Joudeh
- Department of Internal MedicineAl‐Khor Hospital, Hamad Medical CorporationDohaQatar
- Internal Medicine, Collage of MedicineUniversity of QatarDohaQatar
| | | | - Riyadh Hammamy
- Department of Internal MedicineAl‐Khor Hospital, Hamad Medical CorporationDohaQatar
- Internal Medicine, Collage of MedicineUniversity of QatarDohaQatar
| |
Collapse
|
3
|
Meftah N, Sedaghat S, Rabizadeh S, Seifouri S, Nasirimeh K, Nakhjavani M. Graves' disease with pancytopenia: A rare case report. Clin Case Rep 2024; 12:e8312. [PMID: 38188850 PMCID: PMC10769897 DOI: 10.1002/ccr3.8312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/31/2023] [Accepted: 11/11/2023] [Indexed: 01/09/2024] Open
Abstract
Key Clinical Message In this case report we describe a patient with Grave's disease (GD) who was first diagnosed with pancytopenia and did not have any typical symptoms of GD. His hematologic abnormalities were alleviated after treatment with an anti-thyroid drug. Hence, in patients with pancytopenia, GD should also be considered. Abstract A variety of hematologic abnormalities can be seen in Graves' disease (GD), however; here, we describe a patient with GD and a very rare complication; pancytopenia. His hematologic abnormalities and clinical status were alleviated after treatment with an anti-thyroid drug. Hence, in patients with pancytopenia and normal bone marrow examination, GD should also be considered.
Collapse
Affiliation(s)
- Neda Meftah
- Department of Internal Medicine, School of MedicineBabol University of Medical SciencesBabolIran
| | - Sadegh Sedaghat
- Department of Internal Medicine, School of MedicineBabol University of Medical SciencesBabolIran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC)Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Sara Seifouri
- Endocrinology and Metabolism Research Center (EMRC)Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Khatereh Nasirimeh
- Department of Internal Medicine, School of MedicineBabol University of Medical SciencesBabolIran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC)Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| |
Collapse
|
4
|
Lumchee M, Yue M, Laurie J, Morton A. Therapeutic plasma exchange for Graves' disease in pregnancy. Obstet Med 2023; 16:126-129. [PMID: 37441666 PMCID: PMC10334034 DOI: 10.1177/1753495x211031328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 06/04/2024] Open
Abstract
Graves' disease in pregnancy may be associated with maternal, fetal and neonatal complications, which are proportionate to the severity of hyperthyroidism. Optimal management is detailed preconception counselling, achievement of an euthyroid state prior to conception, and close monitoring of thyroid function and thyroid-stimulating antibodies together with judicious use of anti-thyroid medications during pregnancy. A case of Graves' disease in pregnancy, complicated by pancytopenia, with a deterioration in thyroid function following cessation of thionamide therapy is described here. Therapeutic plasma exchange was subsequently used to achieve rapid control prior to thyroidectomy. Therapeutic plasma exchange is an effective treatment for hyperthyroidism where thionamides are ineffective or contraindicated, as a bridge to definitive management.
Collapse
Affiliation(s)
- Matthew Lumchee
- Department of Obstetric Medicine, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Mimi Yue
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Haematology, Mater Hospital, Brisbane, Queensland, Australia
| | - Josephine Laurie
- Department of Obstetric Medicine, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Adam Morton
- Department of Obstetric Medicine, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
5
|
Cheng Y, Xia XY, Zhang W, Ren L, Tian CF, Liu D, Xue G. Clinical characteristics of antithyroid drug-induced aplastic anemia cases over the past 30 years. Front Endocrinol (Lausanne) 2023; 14:1064723. [PMID: 36777352 PMCID: PMC9911543 DOI: 10.3389/fendo.2023.1064723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The authors aimed to investigate the clinical characteristics of antithyroid drug-induced aplastic anemia cases over the past 30 years. METHODS The data of patients with antithyroid drug-induced aplastic anemia were retrieved from PubMed and Wanfang Medical Network databases from 1992 to August 2022. The clinical characteristics, such as age distribution, gender tendency, common symptoms, blood cell count, bone marrow features, treatment strategy, and prognosis, were analyzed. RESULTS A total of 17 cases (male:female = 1:16) had been retrieved. Patients' age ranged from 16 to 74 years (median 50 years). Among them, 82.3% (14/17) of the patients were administered methimazole (MMI), and 78.6% of them had MMI ≥30 mg/day. In addition, 88.2% (15/17) of the patients had sore throat and fever, and 47.1% (8/17) of the patients had hemorrhagic symptoms. Aplastic anemia occurred within 6 months after initiation of the antithyroid therapy in 94.1% of the patients. Agranulocytosis (94.1%) was the most common and earliest blood cell change, and 47.1% of the patients experienced progressive platelet decline during the treatment process. The treatments include timely withdrawal of antithyroid drugs, broad-spectrum antibiotics, granulocyte colony-stimulating factor (G-CSF)/granulocyte-macrophage colony-stimulating factor (GM-CSF), glucocorticoids and other immunosuppressive agents, and supportive treatments such as erythrocyte transfusion and platelet transfusion. Moreover, 70.6% of the patients had complete or near-complete remission within 8 days to 6 weeks. CONCLUSION Aplastic anemia is a rare and serious adverse reaction of antithyroid drugs, which is more common in women. It usually occurs during early treatment with high-dose antithyroid drugs. Most patients have a good prognosis after timely drug ceasing and appropriate treatment.
Collapse
Affiliation(s)
- Ying Cheng
- Department of Endocrinology, The General Hospital of Western Theater Command Chinese People's Liberation Army, Chengdu, Sichuan, China
| | - Xin-Yu Xia
- Department of Endocrinology, The General Hospital of Western Theater Command Chinese People's Liberation Army, Chengdu, Sichuan, China
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Wei Zhang
- Department of Endocrinology, The General Hospital of Western Theater Command Chinese People's Liberation Army, Chengdu, Sichuan, China
| | - Li Ren
- Department of Endocrinology, The General Hospital of Western Theater Command Chinese People's Liberation Army, Chengdu, Sichuan, China
| | - Chen-Fu Tian
- Department of Endocrinology, The General Hospital of Western Theater Command Chinese People's Liberation Army, Chengdu, Sichuan, China
| | - Dan Liu
- Department of Endocrinology, The General Hospital of Western Theater Command Chinese People's Liberation Army, Chengdu, Sichuan, China
| | - Gang Xue
- Department of Thyroid and Breast Surgery, The General Hospital of Western Theater Command Chinese People's Liberation Army, Chengdu, Sichuan, China
- *Correspondence: Gang Xue,
| |
Collapse
|
6
|
周 娴, 辛 颖. [Adverse reactions of methimazole in children with hyperthyroidism]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1252-1258. [PMID: 36398552 PMCID: PMC9678071 DOI: 10.7499/j.issn.1008-8830.2205022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate the incidence rate of adverse reactions of methimazole in children with hyperthyroidism. METHODS A retrospective analysis was performed on the medical data of 304 children with hyperthyroidism who were hospitalized in Shengjing Hospital of China Medical University from January 2015 to May 2021. The incidence rate of methimazole-related adverse reactions was analyzed. The risk factors for common adverse reactions were evaluated. RESULTS Among the 304 children, 87 (28.6%) experienced adverse reactions, among whom there were 20 boys (23%) and 67 girls (77%). Common adverse reactions included neutropenia (12.8%), rash (11.8%), elevated alanine aminotransferase (9.5%), and joint pain (3.0%), and some children experienced multiple adverse reactions simultaneously or intermittently. Neutropenia often occurred within 3 months after administration (25/39, 64%), elevated alanine aminotransferase often occurred within 1 month after administration (17/29, 59%), and rash often occurred within 3 months after administration (30/36, 83%). Most of the above adverse reactions returned to normal after symptomatic treatment. The multivariate logistic regression analysis showed that younger age and lower absolute neutrophil count before treatment were risk factors for neutropenia after methimazole treatment (P<0.05). CONCLUSIONS The adverse reactions of methimazole are common in children with hyperthyroidism, and most adverse reactions occur within 3 months after administration and can be relieved after symptomatic treatment. Children with a younger age or a lower baseline absolute neutrophil count may have a higher risk of neutropenia.
Collapse
|
7
|
Abstract
RATIONALE Pancytopenia and epilepsia are rare complications of Graves' disease (GD). Muscle weakness is a physical sign of GD. It is extremely rare for GD patients to present 3 symptoms at the same time. PATIENT CONCERNS A 35-year-old female was admitted to hospital for dizziness for 1 day. The results of laboratory examination on admission showed pancytopenia and hypothyroidism. Her clinical manifestations include pancytopenia, epilepsy, and muscle weakness. DIAGNOSIS Graves' hyperthyroidism. INTERVENTIONS She received endotracheal intubation, ventilator, antithyroid drugs, and hormone therapy. OUTCOME The patient was discharged after treatment. LESSON Severe complications caused by GD are rare and require antithyroid therapy. Although glucocorticoid is not recommended by the guidelines, it can effectively improve thrombocytopenia.
Collapse
Affiliation(s)
- Bao Fu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Dinghong He
- Department of Critical Care Medicine of Jinsha County People’s Hospital, Bijie City, Guizhou Province, China
| | - Zhengguang Geng
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Xiaoyun Fu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
- * Correspondence: Xiaoyun Fu, Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City 563003, Guizhou Province, China (e-mail: )
| |
Collapse
|
8
|
Scappaticcio L, Bellastella G, Maiorino MI, Giovanella L, Esposito K. Medical treatment of thyrotoxicosis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:113-123. [PMID: 33494589 DOI: 10.23736/s1824-4785.21.03334-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Medical treatment is the primary therapeutic option for thyrotoxicosis/hyperthyroidism. Two groups of causes of thyrotoxicosis (i.e. thyrotoxicosis with hyperthyroidism and thyrotoxicosis without hyperthyroidism) need to be considered for therapeutic reasons. Herein we provide an updated review on the role of conventional medical therapies (i.e. β-blockers, antithyroid drugs [ATDs], corticosteroids, inorganic iodide, perchlorate, cholecystographic agents, lithium, cholestyramine) in the main causes of thyrotoxicosis, starting from the rationale subtending their clinical application.
Collapse
Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, Luigi Vanvitelli University of Campania, Naples, Italy.,Department of Advanced Medical and Surgical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Maria I Maiorino
- Unit of Endocrinology and Metabolic Diseases, Luigi Vanvitelli University of Campania, Naples, Italy.,Department of Advanced Medical and Surgical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy.,Unit of Diabetes, Luigi Vanvitelli University of Campania, Naples, Italy
| |
Collapse
|