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oai:recercat.cat:11351/105792025-10-24T10:22:47Zcom_2072_378070com_2072_378040col_2072_378092

Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study García Gómez, Carlos Navarro, Elena Alcázar, Victoria López-Guzmán, Antonio Arrieta, Francisco EMMA, ANDA Biagetti, Betina Institut Català de la Salut [García Gómez C] Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), Madrid, Spain. Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. [Navarro E] Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, Sevilla, Spain. [Alcázar V] Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Madrid, Spain. [López-Guzmán A] Department of Endocrinology and Nutrition, Complejo Asistencial de Ávila, Ávila, Spain. [Arrieta F] Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain. [Anda E] Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Pamplona, Spain. [Biagetti B] Servei d’Endocrinologia i Nutrició, Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Hipertiroïdisme - Tractament Medicaments - Efectes secundaris Agranulocitosi DISEASES::Endocrine System Diseases::Thyroid Diseases::Hyperthyroidism CHEMICALS AND DRUGS::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormone Antagonists::Antithyroid Agents Other subheadings::Other subheadings::Other subheadings::/adverse effects DISEASES::Hemic and Lymphatic Diseases::Hematologic Diseases::Leukocyte Disorders::Leukopenia::Agranulocytosis Other subheadings::Other subheadings::Other subheadings::/chemically induced ENFERMEDADES::enfermedades del sistema endocrino::enfermedades tiroideas::hipertiroidismo COMPUESTOS QUÍMICOS Y DROGAS::hormonas, sustitutos de hormonas y antagonistas de hormonas::antagonistas de hormonas::antitiroideos Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos ENFERMEDADES::enfermedades hematológicas y linfáticas::enfermedades hematológicas::trastornos leucocitarios::leucopenia::agranulocitosis Otros calificadores::Otros calificadores::Otros calificadores::/inducido químicamente Agranulocitosis; Antitiroideos; Carbimazol Agranulocitosi; Antitiroïdals; Carbimazol Agranulocytosis; Antithyroid; Carbimazole Background: Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/µL) is a rare but serious complication in the treatment of hyperthyroidism. Methodology: Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves’ disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. Results: The median (IQR) time to development of agranulocytosis was 6.0 (4.0–11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves’ disease), and two patients died of septic shock secondary to AIA. Conclusions: AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously. 2023-11-09T09:07:50Z 2023-11-09T09:07:50Z 2023-10-16 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion García Gómez C, Navarro E, Alcázar V, López-Guzmán A, Arrieta F, Anda E, et al. Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study. J Clin Med. 2023 Oct 16;12(20):6556. 2077-0383 https://hdl.handle.net/11351/10579 10.3390/jcm12206556 37892693 http://hdl.handle.net/11351/10579 eng Journal of Clinical Medicine;12(20) https://doi.org/10.3390/jcm12206556 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf MDPI Scientia