Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole-induced agranulocytosis

To report a case of a patient with Graves disease presenting with agranulocytosis induced by methimazole, with subsequent thyroid storm and successful therapeutic use of plasmapheresis. The clinical features and laboratory findings in a patient with agranulocytosis and thyroid storm are presented, a...

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Bibliographic Details
Published in:	Endocrine practice Vol. 16; no. 4; p. 673
Main Authors:	Vyas, Ashish A, Vyas, Priyanka, Fillipon, Nicole Lynn, Vijayakrishnan, Rajakrishnan, Trivedi, Nitin
Format:	Journal Article
Language:	English
Published:	United States 01-07-2010
Subjects:	Adult Agranulocytosis - chemically induced Agranulocytosis - complications Agranulocytosis - immunology Antithyroid Agents - adverse effects Female Graves Disease - complications Graves Disease - drug therapy Graves Disease - immunology Humans Methimazole - adverse effects Plasmapheresis Thyroid Crisis - complications Thyroid Crisis - immunology Thyroid Crisis - surgery Thyroid Crisis - therapy Thyroidectomy Thyrotoxicosis - immunology Thyrotoxicosis - therapy Treatment Outcome
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Summary:	To report a case of a patient with Graves disease presenting with agranulocytosis induced by methimazole, with subsequent thyroid storm and successful therapeutic use of plasmapheresis. The clinical features and laboratory findings in a patient with agranulocytosis and thyroid storm are presented, and the available literature on utilization of plasmapheresis in the setting of thyrotoxicosis is reviewed. A 40-year-old Vietnamese woman with Graves disease was admitted with methimazole-induced agranulocytosis. Treatment with methimazole was discontinued, and therapy with antibiotics, granulocyte colony-stimulating factor, and ibuprofen was initiated. During hospitalization of the patient, her clinical status deteriorated, with development of pericarditis, thrombocytopenia, and thyroid storm. Treatment with plasmapheresis yielded near-euthyroidism in 3 days. Subsequently, she underwent successful total thyroidectomy. Our case highlights the effectiveness of plasmapheresis when clinical situations prohibit the use of traditional treatment methods for thyrotoxicosis or thyroid storm (or both).
ISSN:	1934-2403
DOI:	10.4158/EP09265.CR