Unusual Synchronous Methimazole-Induced Agranulocytosis and Severe Hepatotoxicity in Patient with Hyperthyroidism: A Case Report and Review of the Literature

Table 2

ATD-induced agranulocytosis and severe hepatotoxicity in patients with hyperthyroidism reported previously in the literature.

	Author
	Tran et al. [16]	Jain et al. [13]	Vilchez et al. [12]	Colwell et al. [14]	Hoffman et al. [15]	Present case
Age/gender	29/F	45/F	37/F	60/F	55/F	51/M
ATD	CBZ	CBZ	CBZ	PTU	PTU	MMI
Duration of ATD treatment (days)	19	42	15	28	30	28
Daily dose at the time of diagnosis (mg/d)	30	30	30	300	300	20
Laboratory findings at the time of diagnosis
Granulocyte count (10^9/L)	0	0.032	0.08	0.166	0	0
Liver function
ALT/AST (U/L)	220/97	123/210	44/72	—	165/76	89/30
TB/DB (µmol/L)	104/—	212/133	151/121	186/—	297/—	385/299
Initial treatment
G-CSF	Yes	No	Yes	—	Yes	No
Antibiotic treatment	Yes	Yes	Yes	—	Yes	Yes
Dose of ^131I given (MBq)	Yes	No	555	—	444	296
Recovery period to normal from cessation ATD (days)
Granulocyte count	15	—	34	Death	9	14
Liver function	25	—	69	Death	90	35
Clinical status in thyroid function at follow-up	Subclinical hyperthyroidism	—	Subclinical hyperthyroidism	Death	Euthyroid	Euthyroid

ATD: antithyroid drug; CBZ: carbimazole; PUT: propylthiouracil; MMI: methimazole; ALT: alanine aminotransferase; AST: aspartate aminotransferase; TB: total bilirubin; DB: direct bilirubin; G-CSF: Granulocyte-colony stimulating factor; “—”: not available.