Cargando…

Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center

Background: The most important series devoted to antithyroid drug-induced severe neutropenia and agranulocytosis are Japanese studies, almost specifically in relation to the intake of methimazole. The clinical data of 30 Caucasian patients followed up for antithyroid drug-induced neutropenia at a th...

Descripción completa

Detalles Bibliográficos
Autores principales: Andrès, Emmanuel, Lorenzo-Villalba, Noel, Mourot-Cottet, Rachel, Maloisel, Frédéric, Tebacher, Martine, Gottenberg, Jacques-Eric, Goichot, Bernard, Herbrecht, Raoul, Zulfiqar, Abrar-Ahmad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151575/
https://www.ncbi.nlm.nih.gov/pubmed/32204561
http://dx.doi.org/10.3390/medicines7030015
_version_ 1783521282395996160
author Andrès, Emmanuel
Lorenzo-Villalba, Noel
Mourot-Cottet, Rachel
Maloisel, Frédéric
Tebacher, Martine
Gottenberg, Jacques-Eric
Goichot, Bernard
Herbrecht, Raoul
Zulfiqar, Abrar-Ahmad
author_facet Andrès, Emmanuel
Lorenzo-Villalba, Noel
Mourot-Cottet, Rachel
Maloisel, Frédéric
Tebacher, Martine
Gottenberg, Jacques-Eric
Goichot, Bernard
Herbrecht, Raoul
Zulfiqar, Abrar-Ahmad
author_sort Andrès, Emmanuel
collection PubMed
description Background: The most important series devoted to antithyroid drug-induced severe neutropenia and agranulocytosis are Japanese studies, almost specifically in relation to the intake of methimazole. The clinical data of 30 Caucasian patients followed up for antithyroid drug-induced neutropenia at a third-level hospital are reported. Methods: The data of 30 patients with idiosyncratic antithyroid drug-induced neutropenia and agranulocytosis from a cohort study on drug-induced neutropenia and agranulocytosis conducted at the University Hospital of Strasbourg (France) were retrospectively reviewed. Results: The mean patient age was 61.7 years old (range: 20–87), and the gender ratio (F/M) was 4. Several comorbidities were reported in 23 patients (76.7%), with the mean Charlson comorbidity index of 1. The causative drugs were carbimazole and benzylthiouracil, in 28 (93.3%) and 2 cases, respectively, prescribed primarily for multi-hetero-nodular goiter or thyroid nodule to 18 patients (60%). Sore throat and acute tonsillitis (40%), isolated fever (20%), septicemia (13.3%), documented pneumonia (6.7%), and septic shock (6.7%) were the main clinical features upon admission. The mean neutrophil count at nadir was 0.02 and 0 × 10(9)/L (range: 0–0.3). Regarding the patients’ hospital course: 13 cases (43.3%) worsened during hospitalization, severe sepsis was found in 26.7%, systemic inflammatory response syndrome—in 13.3%, and septic shock—in 3.3% of the cases, respectively. Broad-spectrum antibiotics were indicated for all the patients, and 21 (73.3%) of them received hematopoietic growth factors. Hematological recovery (neutrophil count ≥ 1.5 × 10(9)/L) was seen at 8.3 days (range: 2–24), but faster in those receiving hematopoietic growth factors (4.9 days, p = 0.046). Two patients died during hospitalization, and the rest had a favorable clinical outcome. Conclusions: Antithyroid drug-induced neutropenia represents a serious complication resulting from the rates of severe infections especially in those cases severe neutropenia. In this setting, an established procedure for the management of patients seems useful or even indispensable in view of potential mortality.
format Online
Article
Text
id pubmed-7151575
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-71515752020-04-20 Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center Andrès, Emmanuel Lorenzo-Villalba, Noel Mourot-Cottet, Rachel Maloisel, Frédéric Tebacher, Martine Gottenberg, Jacques-Eric Goichot, Bernard Herbrecht, Raoul Zulfiqar, Abrar-Ahmad Medicines (Basel) Article Background: The most important series devoted to antithyroid drug-induced severe neutropenia and agranulocytosis are Japanese studies, almost specifically in relation to the intake of methimazole. The clinical data of 30 Caucasian patients followed up for antithyroid drug-induced neutropenia at a third-level hospital are reported. Methods: The data of 30 patients with idiosyncratic antithyroid drug-induced neutropenia and agranulocytosis from a cohort study on drug-induced neutropenia and agranulocytosis conducted at the University Hospital of Strasbourg (France) were retrospectively reviewed. Results: The mean patient age was 61.7 years old (range: 20–87), and the gender ratio (F/M) was 4. Several comorbidities were reported in 23 patients (76.7%), with the mean Charlson comorbidity index of 1. The causative drugs were carbimazole and benzylthiouracil, in 28 (93.3%) and 2 cases, respectively, prescribed primarily for multi-hetero-nodular goiter or thyroid nodule to 18 patients (60%). Sore throat and acute tonsillitis (40%), isolated fever (20%), septicemia (13.3%), documented pneumonia (6.7%), and septic shock (6.7%) were the main clinical features upon admission. The mean neutrophil count at nadir was 0.02 and 0 × 10(9)/L (range: 0–0.3). Regarding the patients’ hospital course: 13 cases (43.3%) worsened during hospitalization, severe sepsis was found in 26.7%, systemic inflammatory response syndrome—in 13.3%, and septic shock—in 3.3% of the cases, respectively. Broad-spectrum antibiotics were indicated for all the patients, and 21 (73.3%) of them received hematopoietic growth factors. Hematological recovery (neutrophil count ≥ 1.5 × 10(9)/L) was seen at 8.3 days (range: 2–24), but faster in those receiving hematopoietic growth factors (4.9 days, p = 0.046). Two patients died during hospitalization, and the rest had a favorable clinical outcome. Conclusions: Antithyroid drug-induced neutropenia represents a serious complication resulting from the rates of severe infections especially in those cases severe neutropenia. In this setting, an established procedure for the management of patients seems useful or even indispensable in view of potential mortality. MDPI 2020-03-19 /pmc/articles/PMC7151575/ /pubmed/32204561 http://dx.doi.org/10.3390/medicines7030015 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Andrès, Emmanuel
Lorenzo-Villalba, Noel
Mourot-Cottet, Rachel
Maloisel, Frédéric
Tebacher, Martine
Gottenberg, Jacques-Eric
Goichot, Bernard
Herbrecht, Raoul
Zulfiqar, Abrar-Ahmad
Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center
title Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center
title_full Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center
title_fullStr Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center
title_full_unstemmed Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center
title_short Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center
title_sort severe neutropenia and agranulocytosis related to antithyroid drugs: a study of 30 cases managed in a single reference center
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151575/
https://www.ncbi.nlm.nih.gov/pubmed/32204561
http://dx.doi.org/10.3390/medicines7030015
work_keys_str_mv AT andresemmanuel severeneutropeniaandagranulocytosisrelatedtoantithyroiddrugsastudyof30casesmanagedinasinglereferencecenter
AT lorenzovillalbanoel severeneutropeniaandagranulocytosisrelatedtoantithyroiddrugsastudyof30casesmanagedinasinglereferencecenter
AT mourotcottetrachel severeneutropeniaandagranulocytosisrelatedtoantithyroiddrugsastudyof30casesmanagedinasinglereferencecenter
AT maloiselfrederic severeneutropeniaandagranulocytosisrelatedtoantithyroiddrugsastudyof30casesmanagedinasinglereferencecenter
AT tebachermartine severeneutropeniaandagranulocytosisrelatedtoantithyroiddrugsastudyof30casesmanagedinasinglereferencecenter
AT gottenbergjacqueseric severeneutropeniaandagranulocytosisrelatedtoantithyroiddrugsastudyof30casesmanagedinasinglereferencecenter
AT goichotbernard severeneutropeniaandagranulocytosisrelatedtoantithyroiddrugsastudyof30casesmanagedinasinglereferencecenter
AT herbrechtraoul severeneutropeniaandagranulocytosisrelatedtoantithyroiddrugsastudyof30casesmanagedinasinglereferencecenter
AT zulfiqarabrarahmad severeneutropeniaandagranulocytosisrelatedtoantithyroiddrugsastudyof30casesmanagedinasinglereferencecenter