Endocrine Abstracts

Hyperthyroidism is a condition with the overproduction of thyroid gland’s hormones. One of the treatment option is methimazole, blocking the synthesis named hormones, usually before thyroid surgery or radioactive iodine therapy. I report a 68-year old woman who admitted to hospital in November 2021. after a hematological examination due to leucopoenia and agranulocytosis. She is been treating the hyperthyroidism last 12 years with methimazole. In the beginning she was taking twice daily 10 mg, and later once daily 10 mg of methimazole. Blood counts were normal before as she recalls. She also was treating depression syndrome from the beginning as a hyperthyroidism. Since last year she is been having tonsil problems, difficult swallowing. Last ten days before admitted she had a throat pain, ear pain, no fever and chills. No losing weight. In laboratory findings there were leucopoenia with agranulocytosis leucocyte 1.15/neutrophils 0.33(Absolute number). Her hormones of gland thyroid were in hyperthyroidism range (TSH 0.001 referral range (0.34-5.5), fT3 5.84 ref.r.(2.5-4.5), fT4 2.39 ref.r.(0.58-1.64)). She received a granulocyte grow factor in hematology admission. She had frequent controls of blood count till the leucocyte raised over 1x 10*9 per liter. Her immunology test were negative, other non specific laboratory, ultrasound, radiological chest results. PCR SARS CoV-2 was negative. Palpatory the thyroid gland was large. In ultrasound the lobes were largly, hypoechoic and non homogeneous, roughly echo picture, with several hypoechoic nodule. We consulted the nuclear specialist. The therapy was propylthiouracil 50 mg 1tablet daily with Lugol solution 3 times a day per 2 drops. The control hormones of gland thyroid were: TSH was suppressed, fT3 and fT4 were in referral range. The scintigraphy of thyroid gland was perform with Technetium -99m, where radiopharmaceutical was very weak binding diffuse with some intense binding in one of the nodule in right lobe, and several small ones in left lobes. The therapy option was total thyroidectomy. Her blood count was normal (total recieved 2 ampules of Leucocyte growth factor). She was discharged from hospital. In Decembar she came to check up. No symptoms on her side, blood count with differential blood count were normal. Her TSH was still suppressed, and other hormones of gland thyroid were in referral range. Therapy was the same with recommendations to surgery option Key words:hyperthyreoidism, methimazole, agranulocytosis, granuloyte growth factor