Endocrine Abstracts

Introduction: Hematological toxicity is the main risk of synthetic antithyroid drugs (ATS); the major form is acute agranulocytosis requiring adequate and urgent management. The literature concerning neutropenia and agranulocytosis under ATS is relatively poor, based on rare studies, with often small numbers of patients, and most often concerning American or Japanese populations treated.

Purpose of the study: Report our experience in the endocrinology and metabolic diseases department of the CHU IBN ROCHD in Casablanca, through 5 cases of neutropenia secondary to ATS.

Method: Descriptive retrospective study including patients followed in the endocrinology department of the CHU Ibn Rochd in Casablanca, for hyperthyroidism who presented with neutropenia secondary to ATS during the period 2021–2022.

Results: All our cases were female with an average age of 43 years (24-63 years), two patients (40%) had multi hetero nodular goiter and three patients (60%) were followed for Graves’ disease. Concerning the ATS, all the patients were under carbimazole with an average dose of 22 mg/day (10-30). Only one patient presented with a fever of 39.6°C and erythematous throat with agranulocytosis, while the other four patients had no signs of infection with neutropenia ranging from 580 to 1300/mm3 discovered as part of the monitoring report. Discontinuation of ATS was recommended in all cases with oral corticosteroid therapy (prednisolone at an average dose of 40 mg/d) with three patients who were initially on a bolus of solumedrol. The use of a broad-spectrum antibiotic therapy was envisaged in two patients and that of hematopoietic growth factors in a single patient. The evolution was favorable in four cases with neutropenia (80%) with normalization of PNN and regression of signs of hyperthyroidism, while the patient with agranulocytosis had died in intensive care.

Conclusion: The seriousness of the severe neutropenia and especially of the agranulocytosis which can be observed under ATS, justifies good patient education as well as close monitoring of the blood count, in particular during the first two months of treatment.