#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Severe autoimune thyreotoxicosis complicated by febrile neutropenia as a result of thyreostatic therapy


Authors: Marie Jarolímová;  Michal Kazmíř
Authors‘ workplace: Interní oddělení, Oblastní nemocnice Kolín, a. s.
Published in: Vnitř Lék 2023; 69(E-2): 19-22
Category: Case reports
doi: https://doi.org/10.36290/vnl.2023.024

Overview

Hyperthyreoidism is a clinical manifestation of excessive production of thyroid hormones. In most cases pacient ´s condition allows ambulant treatment. Rarely, it can develop into an acute, life- threatening thyrotoxic crisis which has to be treated in the intensive care unit. Main therapy includes antithyroid medication, corticosteroids, beta- blockers and rehydratation, mostly parenteral. If initial treatment fails, plasmapheresis provides effective strategy.

Antithyroid medication may come with side effects as rash, digestive issues, joint pain.Agranulocystosis or acute liver lesion which leads to liver failure belong among the most severe ones. In this case we report a pacient with thyrotoxic crisis, atrial fibrilation which led to ventricular fibrilation, cor thyreotoxicum. The treatment was complicated by febrile neutropenia.

Keywords:

agranulocytosis – hyperthyreoidism – Lugol solution – total thyreoidectomy – thyrotoxic crisis


Sources

1. Marek J, Hána V, et al. Endokrinologie. Galén: Praha: 2019:272-274. ISBN 978-80-7262-484-3.

2. Čepková J, Gabalec F, Svilias I, et at. Výskyt agranulocytózy po tyreostaticích v kohortě pacientů s Gravesovou nemocí léčených radioaktivním jodem 131I v průběhu 14 let. Vnitr Lek. 2014;60(10):832-836.

3. Pokhrel B, Aiman W, Bhusal K. Thyroid Storm. In: StatPearls. Treasure Island: StatPearls Publishing; 2022. Dostupné z WWW: <https://www.ncbi.nlm.nih.gov/books/NBK448095/>.

4. Pelikánová T, Zamrazil V, et al. Akutní stavy v endokrinologii. Galén: Praha: 2007:44-55. ISBN 978-80-7262-478-2.

5. Chiha M, Samarasinghe S, Kabaker AS. Thyroid Storm: An Updated Review. J Intensive Care Med. 2015;30(3):131-140. Dostupné z DOI: < https://doi.org/10.1177/0885066613498053>.

6. Jiskra J. Akutní stavy v tyreologii. Kardiol Rev Int Med. 2015;17(2):172-177.

7. Lim SL, Wang K, Lui PL, et al. Crash Landing of Thyroid Storm: A Case Report and Review of the Role of Extra‑Corporeal Systems. Front Endocrinol (Lausanne). 2021; Dostupné z DOI: https:// doi.org/10.3389/fendo.2021.725559>.

8. Angell TE, Lechner MG, Nguyen CT, et al. Clinical Features and Hospital Outcomes in Thyroid Storm: A Retrospective Cohort Study. J Clin Endocrinol Metab. 2015;100(2):451-459. Dostupné z DOI: <https://doi.org/10.1210/jc.2014-2850>.

9. Maurer E, Vorländer C, Zielke A, et al. Short‑Term Outcomes of Surgery for Graves Disease in Germany. J Clin Med. 2020;9(12):4014. Available from: https://doi.org/10.3390/ jcm9124014.

10. Ross DS, Burch HB, Cooper David S, et al. American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. J Thyroid. 2016; 26(10):1343-1421 Available from: z DOI:<http://doi.org/10.1089/thy.2016.0229>.

11. Carroll R, Matfin G. Endocrine and metabolic emergencies: thyroid storm. Ther Adv Endocrinol Metab. 2010;1(3):139-45. Available from: DOI: < doi.org/10.1177/2042018810382481/>

12. Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. 2006;35(4):663-86, Available from: DOI: <doi.org/10.1016/j.ecl.2006. 09. 008>.

13. Abraham P, Acharya S. Current and emerging treatment options for Graves hyperthyroidism. Ther Clin Risk Manag. 2010;2(6):29-40. Available from: DOI: <https://doi.org/10.2147/ TCRM.S5229>.

14. Límanová Z. Výskyt agranulocytózy po tyreostaticích v kohortě pacientů s Gravesovou nemocí léčených radioaktivním jodem 131I v průběhu 14 let – editorial. Vnitr Lek. 2014;60(10):815-816.

15. Bai XS, Liu JH, Xiao SM. A patient with agranulocytosis following the discontinuation of methimazole treatment for 4 months: A case report. Exp Ther Med. 2014;8(3):823-825. Available from: DOI: <https://doi.org/10.3892/etm.2014.1817>.

16. Sprikkelman A, de Wolf JT, Vellenga E. The application of hematopoetic growth factors in drug‑induced agranulocytosis: a review of 70 cases. J Leukemia. 1994;8(12):2031-2036.

17. Nakamura H, Miyauchi A, Miyawaki N, et al. Analysis of 754 Cases of Antithyroid Drug‑Induced Agranulocytosis Over 30 Years in Japan. J Clin Endocrinol Metab. 2013; 98(12): 4776- 4783. Available from: DOI: <https://doi.org/10.1210/jc.2013-2569>.

Labels
Diabetology Endocrinology Internal medicine
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#