Endocrine Abstracts

A 55 year-old Nepalese lady, previously fit and well, presented to her GP 2 months ago with palpitations and weight loss. She was diagnosed with Graves thyrotoxicosis based on her clinical history and biochemistry, and was started on carbimazole 40 mg daily. She suffered from COVID19 infection a month later and started self-isolating. She continued to feel unwell for three weeks but did not seek urgent medical attention due to the perceived general recommended isolation guidelines. When she presented to the hospital, she was acutely unwell with pyrexia, hypotension and tachycardia. Blood tests revealed severe neutropenia with raised CRP. COVID lateral flow and PCR remained positive. She was treated for unresolved COVID19 infection and agranulocytosis secondary to carbimazole. She was started on filgrastim, intravenous fluids and antibiotics. Carbimazole was stopped and steroids were not indicated as she was saturating well on air and her thyroid blood tests at that time was euthyroid. Definitive thyroid treatment was discussed and thyroidectomy was planned urgently. She was started on high dose beta-blocker when clinically better. Unfortunately, she became severely thyrotoxic again within two weeks and was therefore optimised with Lugol iodine, steroids and high dose beta-blocker prior to total thyroidectomy. This case described an unwell patient with slow recovery from COVID19 infection due to presence of agranulocytosis. It also highlighted the importance of going through the rare agranulocytosis side effect of carbimazole with patient and with the ongoing COVID19 pandemic, patient should be reminded of the importance of seeking urgent medical attention and blood test if unwell or suffering from COVID19 infection, despite the recommended isolation guidelines. The latter is particularly crucial if the COVID19 symptoms persist for a prolonged period. Carbimazole counselling should therefore include the context of COVID19 infection and patients on this medication should be given the drug alert card.