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García Gómez C, Navarro E, Alcázar V, López-Guzmán A, Arrieta F, Anda E, Biagetti B, Guerrero-Pérez F, Villabona C, de Assín Valverde AR, Lamas C, Lecumberri B, Rosado Sierra JA, Sastre J, Díez JJ, Iglesias P. Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study. J Clin Med 2023; 12:6556. [PMID: 37892693 PMCID: PMC10607319 DOI: 10.3390/jcm12206556] [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: 09/13/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/µL) is a rare but serious complication in the treatment of hyperthyroidism. METHODOLOGY Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves' disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. RESULTS The median (IQR) time to development of agranulocytosis was 6.0 (4.0-11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves' disease), and two patients died of septic shock secondary to AIA. CONCLUSIONS AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously.
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Affiliation(s)
- Carlos García Gómez
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (J.J.D.); (P.I.)
- Department of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Elena Navarro
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain;
| | - Victoria Alcázar
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, 28914 Madrid, Spain;
| | - Antonio López-Guzmán
- Department of Endocrinology and Nutrition, Complejo Asistencial de Ávila, 05004 Ávila, Spain;
| | - Francisco Arrieta
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Emma Anda
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Hospital Universitari Vall d’Hebrón, 08035 Barcelona, Spain;
| | - Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (C.V.)
| | - Carles Villabona
- Department of Endocrinology and Nutrition, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (C.V.)
| | - Andrés Ruiz de Assín Valverde
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Albacete, 02008 Albacete, Spain (C.L.)
| | - Cristina Lamas
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Albacete, 02008 Albacete, Spain (C.L.)
| | - Beatriz Lecumberri
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | | | - Julia Sastre
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Toledo, 45007 Toledo, Spain;
| | - Juan José Díez
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (J.J.D.); (P.I.)
- Department of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (J.J.D.); (P.I.)
- Department of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
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García Izquierdo B, Contreras Angulo M, Armengod Grao L, García García Á, Iglesias P. Role of plasmapheresis in the management of severe amiodarone-induced hyperthyroidism refractory to conventional medical treatment. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:68-71. [PMID: 37598006 DOI: 10.1016/j.endien.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/08/2022] [Indexed: 08/21/2023]
Affiliation(s)
- Belén García Izquierdo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Macarena Contreras Angulo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Laura Armengod Grao
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Álvaro García García
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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García Izquierdo B, Contreras Angulo M, Armengod Grao L, García García Á, Iglesias P. Papel de la plasmaféresis en el manejo del hipertiroidismo severo inducido por amiodarona y refractario a tratamiento médico convencional. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mehmood R, Khan MS, Hussain S, Ahmed A, Arshad FA, Mukhtar R. Monitoring and Evaluation of Thyroid Function Tests, Serum Electrolytes and Creatinine Levels Before and After 131I Therapy. Endocr Metab Immune Disord Drug Targets 2020; 20:419-424. [DOI: 10.2174/1871530319666190829163413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/06/2019] [Accepted: 05/28/2019] [Indexed: 11/22/2022]
Abstract
Background:
Serum electrolytes, Creatinine, and thyroid profile play an important role in
131I treated patients of thyroid disorders.
Objectives:
To determine the effect of radioactive iodine (131I) on renal parameters, serum electrolytes
and the correlation among TFT’S, creatinine, and chloride levels before and after I131 treatment in
thyroid disorders.
Methods:
The study was performed on 55 patients of thyrotoxicosis with age ranging from 16-65 years
(mean age= 41±14years and BMI=24.8±4.46). The significance of the differences between the results
of 1st, 2nd, and 3rd-time serum analysis was assessed by paired Student's t-test. Association between
parameters was assessed by Spearman correlation analysis.
Results:
40 patients were taking Carbimazole, and 15 were directly recommended for I131 therapy.
Strongly significant variations were observed for TFT’S (T3=0.012, T4 =0.017, and TSH=0. 001) during
the follow-up treatment. Before taking I131 (Serum analyzed at 1st time), there observed negative
correlation of T3(r=-.46, p=0. 002) and TSH (r=-0.31, p=0.02) with creatinine, and positive correlation
of TSH(r=0.29,p=0.02) with chloride. BMI was negatively correlated with potassium(r=-0.30, p=0.02).
At the 2nd time (after stopping the Carbimazole), no correlation results were observed. Two months
after oral administration of 131I, creatinine, and chloride level was significantly increased (p=0.000),
(P=0. 03) respectively, but had no correlation with TFT’S.
Conclusion:
Our findings suggest that patients with goiter (diffused or toxic) have association of TFT’S
and BMI with serum electrolytes and creatinine, 131I therapy is also associated with the increase in
creatinine and chloride levels of patients leading to kidney problems.
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Affiliation(s)
- Rubaida Mehmood
- Diagnostics Labs and Nuclear Medicine Department, Multan Institute of Nuclear Medicine and Radiotherapy (MINAR), PAEC, Multan, Pakistan
| | - Muhammed S. Khan
- Diagnostics Labs and Nuclear Medicine Department, Multan Institute of Nuclear Medicine and Radiotherapy (MINAR), PAEC, Multan, Pakistan
| | - Sajid Hussain
- Diagnostics Labs and Nuclear Medicine Department, Multan Institute of Nuclear Medicine and Radiotherapy (MINAR), PAEC, Multan, Pakistan
| | - Akhlaque Ahmed
- Diagnostics Labs and Nuclear Medicine Department, Multan Institute of Nuclear Medicine and Radiotherapy (MINAR), PAEC, Multan, Pakistan
| | | | - Rubina Mukhtar
- Diagnostics Labs and Nuclear Medicine Department, Multan Institute of Nuclear Medicine and Radiotherapy (MINAR), PAEC, Multan, Pakistan
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Arias N, Moreno-Pérez Ó, Boix E, Serrano J, Revert P, González VL, Sánchez-Ortiga R, Picó AM. [Response to adjuvant therapy with potassium perchlorate in amiodarone-induced thyrotoxicosis: observations on three cases]. ACTA ACUST UNITED AC 2011; 58:121-6. [PMID: 21367680 DOI: 10.1016/j.endonu.2010.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/30/2010] [Accepted: 12/09/2010] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Amiodarone-induced thyrotoxicosis (AIT) is a common clinical disorder that may be life threatening and whose clinical manifestations and response to treatment may vary among patients. METHODS We present three patients treated with amiodarone for atrial fibrillation who developed AIT at least 36 months after beginning the treatment. Thyrotoxicosis worsened the underlying cardiac disorders and was resistant to treatment based on the combination of dexamethasone 8-12 mg/day i.v., thioamides 45 mg/day p.o., beta blockers and potassium perchlorate at doses of 800 to 1000 mg per day p.o. Two of the patients attained sustained euthyroidism after 12 and 32 days of combined treatment, while the third required total thyroidectomy. CONCLUSION The combination of thioamides with potassium perchlorate is an appropriate form of therapy for AIT in patients resistant to thioamides. The use of this combination should be evaluated in patients with mixed AIT or AIT of unclear etiology.
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Affiliation(s)
- Nieves Arias
- Sección de Endocrinología y Nutrición, Hospital General Universitario de Alicante, Alicante, España.
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Abstract
Thyroid hormones (TH) are essential for an adequate growth and development of the kidney. Conversely, the kidney is not only an organ for metabolism and elimination of TH, but also a target organ of some of the iodothyronines' actions. Thyroid dysfunction causes remarkable changes in glomerular and tubular functions and electrolyte and water homeostasis. Hypothyroidism is accompanied by a decrease in glomerular filtration, hyponatremia, and an alteration of the ability for water excretion. Excessive levels of TH generate an increase in glomerular filtration rate and renal plasma flow. Renal disease, in turn, leads to significant changes in thyroid function. The association of different types of glomerulopathies with both hyper- and hypofunction of the thyroid has been reported. Less frequently, tubulointerstitial disease has been associated with functional thyroid disorders. Nephrotic syndrome is accompanied by changes in the concentrations of TH due primarily to loss of protein in the urine. Acute kidney injury and chronic kidney disease are accompanied by notable effects on the hypothalamus-pituitary-thyroid axis. The secretion of pituitary thyrotropin (TSH) is impaired in uremia. Contrary to other non-thyroidal chronic disease, in uraemic patients it is not unusual to observe the sick euthyroid syndrome with low serum triodothyronine (T(3)) without elevation of reverse T(3) (rT(3)). Some authors have reported associations between thyroid cancer and kidney tumors and each of these organs can develop metastases into the other. Finally, data from recent research suggest that TH, especially T(3), can be considered as a marker for survival in patients with kidney disease.
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Affiliation(s)
- P Iglesias
- Department of Endocrinology, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain.
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