International Journal of Endocrinology / 2015 / Article / Tab 2

Clinical Study

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/gender29/F45/F37/F60/F55/F51/M
ATD CBZCBZCBZPTUPTUMMI
Duration of ATD treatment (days)194215283028
Daily dose at the time of diagnosis (mg/d)30303030030020
Laboratory findings at the time of diagnosis
 Granulocyte count (109/L)00.0320.080.16600
 Liver function
 ALT/AST (U/L)220/97123/21044/72165/7689/30
 TB/DB (µmol/L)104/—212/133151/121186/—297/—385/299
Initial treatment
 G-CSFYesNoYesYesNo
 Antibiotic treatment YesYesYesYesYes
Dose of 131I given (MBq)YesNo555444296
Recovery period to normal from cessation ATD (days)
 Granulocyte count1534Death914
 Liver function2569Death9035
Clinical status in thyroid function at follow-upSubclinical hyperthyroidismSubclinical hyperthyroidismDeathEuthyroidEuthyroid

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.

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