Antithyroid drugs as treatment of neutropenia in hyperthyroidism

Sawsen Essayeh; Manel Jemel; Hiba Chatti; Wiem Madhi; Radhouane Gharbi; Hajer Kandara; Ines Kammoun

doi:10.1530/endoabs.73.AEP709

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Endocrine Abstracts (2021) 73 AEP709 | DOI: 10.1530/endoabs.73.AEP709

ECE2021 Audio Eposter Presentations Thyroid (157 abstracts)

Antithyroid drugs as treatment of neutropenia in hyperthyroidism

Sawsen Essayeh ¹ , Manel Jemel ² , Hiba Chatti ¹ , Wiem Madhi ¹ , Radhouane Gharbi ² , Hajer Kandara ² & Ines Kammoun ²

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¹National Institute of Nutrition and Food Technology, Department of Endocrinology, Tunis, Tunisia; ²National Institute of Nutrition and Food Technology El Manar University, Department of Endocrinology, Tunis, Tunisia

Introduction

Hematological abnormalities are frequently observed in hyperthyroidism and are part of complex, multifactorial pathogenetic mechanisms that are still poorly understood, which can affect the three hematopoietic lineages in isolation or in combination. For the endocrinologist, they raise the issue of the risk of their aggravation under the hamatotoxic effect of antithyroid drugs (ATDs).

Case presentation

A 28-year-old man, with no particular past medical history, presented palpitations with irritability and weight loss. Hormonal tests revealed hyperthyroidism: free thyroxine (FT4) =38 pmol/l (reference: 8.6–25 pmol/l) and thyroid stimulating-hormone (TSH) < 0.005 µUI/ml (reference: 0.4–4 µUI/ml). The physical examination didn’t find a goiter or eye signs. TSH receptor autoantibodies were positive at 12, 6 UI/l (reference: <1 UI/l). Therefore, the diagnosis of Graves ’disease was made. The complete blood count (CBC) showed a neutropenia with polynuclear neutrophils (PNN) = 800/mm³ controlled at 850/mm³. After obtaining the consent of the patient, a treatment with ATDs was started and the CBC after five days of treatment showed PNN at 1080/mm³ and 1200/mm³ after 12 days. The ATDs were maintained and the PNN were 2300/mm³ after euthyroidism.

Conclusion

The threshold of neutropenia contraindicating the prescription of ATDs could well be lowered with vigilance and warning of the patient. Some authors speak of the physiological phenomenon of margination of white blood cells falsely underestimating the count of the lineage, a situation worsened by hyperthyroidism but bot contraindicating the introduction of ATD.