Unusual Synchronous Methimazole-Induced Agranulocytosis and Severe Hepatotoxicity in Patient with Hyperthyroidism: A Case Report and Review of the Literature
Table 1
Clinical course of laboratory findings.
Week
Action
FT3
FT4
TSH
ALT
AST
TB
DB
PT
WBC
Granulocytes
Normal range
3.23–7.22 pmol/L
10.3–24.45 pmol/L
0.4–4.0 mIU/L
5–40 U/L
8–40 U/L
0–21 µmol/L
1–5 µmol/L
10–13.5 s
4.0–10.0 × 109/L
2.0–7.0 × 109/L
−4
Diagnosis MMI 20 mg/day started
12.78
56.72
0.001
30
21
12
7
—
4.2
2.2
0
MMI stopped
5.61
37.1
0.001
89
30
385
299
17
1.1
0
1
4.15
30.8
0.009
35
22
390
224
16
2.3
0.5
2
5.86
22.3
0.009
30
22
158
122
—
5.9
3.1
3
131I treatment with 8 mCi
9.42
32.8
0.009
37
22
95
42
13
9.1
6.6
5
—
—
—
32
21
20
12
—
5.1
2.9
15
4.4
13.6
0.009
22
23
16
8
—
4.8
2.6
27
4.4
10.6
2.1
18
18
15
7
—
4.9
2.3
FT3: free triiodothyronine; FT4: free thyroxine; TSH: thyroid stimulating hormone; ALT: alanine aminotransferase; AST: aspartate aminotransferase; TB: total bilirubin; DB: direct bilirubin; PT: prothrombin time; WBC: white blood count; “—” means no such examinations were done.
