Thionamide Associated Agranulocytosis: Low Incidence with Low Doses of Methimazole

A Bahrami

International Journal of Endocrinology and Metabolism

Research Institute for Endocrine Sciences

Current Issue All Issues In Press Search

Journal Information Boards and Committees Indexing and Listing Sources Journal Metrics Open Peer Review (OPR)Publication Ethics and Malpractice Statement Reviewer and AE Registration Form Support Contact Us

APC

Authors Guide Submit Manuscript

Thionamide Associated Agranulocytosis: Low Incidence with Low Doses of Methimazole

Author(s):

A Bahrami^1,*

1Division of Endocrinology and Metabolism, Department of Medicine, Tabriz University of Medical Sciences, [email protected], I.R.Iran

International Journal of Endocrinology and Metabolism:Vol. 4, issue 4; 210-215

Published online:Oct 31, 2006

Article type:Research Article

Received:Jan 15, 2005

Accepted:Nov 05, 2005

How to Cite:Bahrami A. Thionamide Associated Agranulocytosis: Low Incidence with Low Doses of Methimazole. Int J Endocrinol Metab. 2006;4(4):. doi:

Abstract

Agranulocytosis is an uncommon but most serious adverse side effect of thiouracil. It has been reported to affect 0.3% – 0.6% of patients treated with thiourea–derivates. Both methimazole (MMI) and propylthiuracil (PTU) can cause agranulocytosis. Some data indicate that low doses of MMI are associated with lower prevalence of agranulocytosis than either high-dose MMI or conventional doses of PTU. The aim of the present study was to determine the frequency of thionamide-associatied agranulocytosis and to clarify the role of clinical factors such as gender and age of patient, duration of antithyroid therapy, dosage and type of thionamide used, in the development of agranulocytosis.

Materials and Methods: The medical records of all patients with hyperthyroid disease, treated with either MMI or PTU in endocrine clinics, were reviewed retrospectively with regard to agranulocytosis, patient age and sex, duration of antithyroid therapy, diagnosis, dosage, and type of thionamide used. Between April 1985 and September 2004, a total of 21,800 patients with hyperthyroidism due to Graves_ disease or toxic multinodular goiter received long term treatment (mean duration of treatment of 15.7±8.4 months) with either MMI or PTU at endocrine clinics of Tabriz University of Medical Sciences. Of these, 20,840 (95.6%) patients were treated with MMI and the remainder 960 (4.4%) received PTU.

Results: Classic agranulocytosis, defined as severe neutropenia, accompanied by serious symptoms and signs of infection developed in seven cases, 5 in MMI group and 2 in PTU treated patients. Thus the overall prevalence of thiomamide– associated agranulocytosis in this study is about 0.03 percent. There was no significant difference between mean ages of patients with and without agranulocytosis (42.2±14.8 vs 45.4±13.7 years). In the majority of cases, agranulocytosis occurred during the first 2 months of treatment.

There was no case with agranulocytosis among 15,412 individuals treated with low doses of MMI (< 20 mg/day).

Conclusion: In conclusion the majority of cases of agranulocytosis occurred within the first few weeks of initiation of antithyroid therapy. This side effect may occur at any times, regardless of patient age, gender or duration of treatment. It seems that the likelihood of agranulocytosis is diminished at low doses of MMI.

Keywords

Thionamides

Agranulocytosis

Hyperthyroidism

Full Text

Full text is available in PDF

Methimazole-Induced Agranulocytosis in a Mother and her Young Daughter, the Possible Role of Genetic Factors in the Development of Methimazole- Induced Agranulocytosis

A Bahrami

Bahrami A. Methimazole-Induced Agranulocytosis in a Mother and her Young Daughter, the Possible Role of Genetic Factors in the Development of Methimazole- Induced Agranulocytosis. Int J Endocrinol Metab. 2006;4(2):. doi:

31

Jan

2006

Amiodarone-Induced Thyrotoxicosis

S Brogioni,

E DellUnto,

C Cosci,

L Tomisti,

L Bartalena,

E Martino

,et al.

Brogioni S, DellUnto E, Cosci C, Tomisti L, Bartalena L, et al. Amiodarone-Induced Thyrotoxicosis. Int J Endocrinol Metab. 2006;4(1):. doi:

21

Aug

2024

Treatment Challenges of Methimazole-Induced Agranulocytosis in Younger Patients

Azadeh Kiumarsi,

Reza Mohamadhosseinzadeh Davatgari,

Maryam Habibi,

Mahsa Soti Khiabani

Kiumarsi A, Mohamadhosseinzadeh Davatgari R, Habibi M, Soti Khiabani M. Treatment Challenges of Methimazole-Induced Agranulocytosis in Younger Patients. Inn J Pediatr. 2024;34(5):e140262. doi: https://doi.org/10.5812/ijp-140262

31

Dec

2019

Antithyroid Drugs

Hengameh Abdi,

Atieh Amouzegar,

Fereidoun Azizi

Abdi H, Amouzegar A, Azizi F. Antithyroid Drugs. Iran J Pharm Res. 2019;18(Suppl1):e124684. doi: https://doi.org/10.22037/ijpr.2020.112892.14005

29

Sep

2012

Recombinant TSH and Lithium Overcomes Amiodarone-Induced Low Radioiodine Uptake in a Thyrotoxic Female

Nestor Eric R. Laplano,

Leilani B. Mercado-Asis

Laplano NER, Mercado-Asis LB. Recombinant TSH and Lithium Overcomes Amiodarone-Induced Low Radioiodine Uptake in a Thyrotoxic Female. Int J Endocrinol Metab. 2012;10(4):. doi: https://doi.org/10.5812/ijem.5406

Import into EndNote Import into BibTex

Share on

Comments

Number of Comments:0

Cited by

Scopus by DOI: 0
Last Update: 2 weeks ago
Scopus by Title: 0
Last Update: 2 weeks ago
Scopus by Title (Ref): 1
Last Update: 2 weeks ago
CrossRef: 0
Last Update: 9 hours ago

Metrics

Ordering Reprints

Articles are published under the Creative Commons license stated on each article. No permission or royalty fee is required for uses permitted by that license. CCC handles optional bulk and customized reprint orders. Any quotation covers production and delivery services only, not copyright permission. > Request Reprints from CCC

Search Relations

Author(s):

A Bahrami:[PubMed][Scholar]

Research Institute for Endocrine Sciences

Outlines

Thionamide Associated Agranulocytosis: Low Incidence with Low Doses of Methimazole

Abstract

Full Text

Similar Articles

Methimazole-Induced Agranulocytosis in a Mother and her Young Daughter, the Possible Role of Genetic Factors in the Development of Methimazole- Induced Agranulocytosis

Amiodarone-Induced Thyrotoxicosis

Treatment Challenges of Methimazole-Induced Agranulocytosis in Younger Patients

Antithyroid Drugs

Recombinant TSH and Lithium Overcomes Amiodarone-Induced Low Radioiodine Uptake in a Thyrotoxic Female

Last Update: 2 weeks ago

Last Update: 2 weeks ago

Last Update: 2 weeks ago

Last Update: 9 hours ago