The treatment of hyperthyroidism with methimazole in a pregnant who developed agranulocytosis due to propylthiouracil

Authors

DOI:

https://doi.org/10.5281/zenodo.7130554

Keywords:

Agranulocytosis, graves disease, methimazole, pregnant women, propylthiouracil

Abstract

The most common cause of hyperthyroidism during pregnancy is Graves' disease. Anti-thyroid drugs are primarily used in the treatment of pregnant women with Graves’ disease. Anti-thyroid drugs’ side effects include itching, jaundice, skin rash, drug fever, arthralgia, lupus-like syndrome, toxic hepatitis, vasculitis, hypergammaglobulinemia, and lymphadenopathy.  Although agranulocytosis, a serious side effect of anti-thyroid drugs, is rare, it is difficult to treat when it occurs during pregnancy. In this article, we aimed to present a pregnant case with Graves' disease who developed agranulocytosis after the initiation of propylthiouracil, whose agranulocytosis was treated with granulocyte colony-stimulating factor, and subsequently, hyperthyroidism was treated with methimazole without any problem.

References

Smith TJ, Hegedus L. Graves’ disease. N Engl J Med. 2016;375:1552–65.

Dong AC, Stagnaro-Green A. Differences in diagnostic criteria mask the true prevalence of thyroid disease in pregnancy: a systematic review and metaanalysis. Thyroid. 2019;29:278–289.

Bural GG, Laymon CM, Mountz JM. Nuclear imaging of a pregnant patient: should we perform nuclear medicine procedures during pregnancy? Mol Imaging Radionucl Ther. 2012;21(1):1-5.

Laurberg P, Bournaud C, Karmisholt J, Orgiazzi J. Management of Graves’ hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. Eur J Endo-crinol. 2009;160(1):1–8.

Kobaly K, Mandel SJ. Hyperthyroidism and Pregnancy. Endocrinol Metab Clin North Am. 2019;48(3):533-545.

Mortimer RH, Cannell GR, Addison RS, Johnson LP, Roberts MS, Bernus I, et al. Methimazole and propylthiouracil equally cross the perfused human term placental lobule. J Clin Endocrinol Metab. 1997;82:3099-3102.

Bahn RS, Burch HS, Cooper DS, Garber JR, Greenlee CM, Klein IL, et al. The role of propylthiouracil in the management of Graves' disease in adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. 2009;19:673-674.

Davis LE, Lucas MJ, Hankins GD, Roark ML. Cunningham FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol. 1989;160(1):63–70

Vicente N, Cardoso L, Barros L, Carrilho F. Antithyroid Drug-Induced Agranulocytosis: State of the Art on Diagnosis and Management. Drugs R D. 2017;17(1):91-96.

Sun MT, Tsai CH, Shih KC. Antithyroid drug-induced agranulocytosis. J Chin Med Assoc. 2009;72(8):438-41.

Andersohn F, Konzen C, Garbe E. Systematic review: agranulocytosis induced by nonchemotherapy drugs. Ann Intern Med. 2007;146:657-665.

Tamai H, Mukuta T, Matsubayashi S, Fukata S, Komaki G, Kuma K, et al. Treatment of methimazole-induced agranulocytosis using recombinant human granulocyte colony stimulating factor (rhG-CSF). J Clin Endocrinol Metab. 1993;77:1356-1360.

Zeidler C, Grote UA, Nickel A, Brand B, Carlsson G, Cortesao E, et al. Outcome and management of pregnancies in severe chronic neutropenia patients by the European Branch of the Severe Chronic Neutropenia International Registry. Haematologica. 2014;99(8):1395-1402.

Boxer LA, Bolyard AA, Kelley ML, Marrero TM, Phan L, Bond JM, et al. Use of granulocyte colony-stimulating factor during pregnancy in women with chronic neutropenia. Obstet Gynecol. 2015;125(1):197-203.

Degerli V, Yilmaz Duran F, Kucuk M, Atasoy I. A rare cause of neutropenic enterocolitis: Propylthiouracil-induced agranulocytosis. Hong Kong Journal of Emergency Medicine. 2018;25(5):286-289.

Topcu R, Baş Y, Sezikli İ, Erenler BH, Kefeli M, Topcu H. A very rare malignant tumor of the thyroid gland: A case report of primary osteosarcoma. The Injector. 2022;1(1):36-9.

Downloads

Published

2022-09-30

How to Cite

1.
Mamiş MS, Uyar N, Eren MA, Sabuncu T. The treatment of hyperthyroidism with methimazole in a pregnant who developed agranulocytosis due to propylthiouracil. J Clin Trials Exp Investig [Internet]. 2022 Sep. 30 [cited 2024 Jul. 24];1(2):56-9. Available from: https://jctei.com/index.php/jctei/article/view/15