Case analysis of antithyroid drug-induced agranulocytosis combined with fatal complications / 西安交通大学学报(医学版)

ABSTRACT

Objective: To investigate the clinical characteristics of patients with antithyroid drug (ATD)-induced agranulocytosis in the treatment of hyperthyroidism and analyze factors associated with the death rate of patients with fatal outcomes. Methods:Patients diagnosed with ATD-induced agranulocytosis in Department of Endocrinology, the First Affiliated Hospital of Xi'an Jiaotong University from January 2000 to December 2018, were included in this study and their medical records were reviewed retrospectively. We compared the clinical characteristics of patients in death group and survival group. Results: We recruited 70 patients with ATD-induced agranulocytosis in the study. Five of them died. All fatal cases were females, aged between 33 to 54 years. Three patients also had hyperthyroidism crisis, and two had hyperthyroid heart disease. Compared with the survival cases of ATD-induced agranulocytosis, patients with fatal agranulocytosis were elderly [47.00±8.12)years vs. (35.58±11.10) years, P=0.028] and had a longer duration of hyperthyroidism [1 800 (315-2 880)d vs. 60(40-120)d, P=0.002]. The interval days between symptoms and the diagnosis of agranulocytosis were significantly longer in patients with fatal cases than the survival ones[5.0(3.5-11.0)d vs. 0(0-2.5) d, P=0.002]. In addition, the proportion of patients with hyperthyroid crisis was greater in the death group (60% vs. 0%, P<0.001). Conclusion: Age, duration of hyperthyroidism, and timely diagnosis of agranulocytosis could affect the mortality of agranulocytosis. Mortality in patients with hyperthyroidism was significantly increased. It is recommended that patients with hyperthyroidism should be reminded to monitor routine blood cells immediately. In the event of agranulocytosis, other methods should be chosen as soon as possible to treat hyperthyroidism and avoid serious outcomes.