[Hyperthyroid and acute tonsillitis in a 23-year-old woman]

Area of Science:

• Endocrinology
• Hematology
• Pharmacology

Background:

• Graves' disease is an autoimmune disorder leading to hyperthyroidism.
• Thiamazole is a common antithyroid medication used to manage hyperthyroidism.
• Drug-induced agranulocytosis is a serious adverse effect associated with thiamazole therapy.

Observation:

• A 23-year-old woman with pre-existing Graves' disease on thiamazole presented with fever, dysphagia, hyperthyroidism, and leukopenia.
• The patient's condition was suspected to be thyrotoxicosis with drug-induced agranulocytosis.

Findings:

• Successful management was achieved through plasmapheresis, granulocyte-colony stimulating factor (G-CSF) administration, and inhibition of peripheral thyroid hormone conversion.
• The patient subsequently underwent thyroidectomy for definitive treatment.

Implications:

• Thiamazole is frequently linked to drug-induced agranulocytosis, necessitating careful monitoring and evaluation of long-term use.
• Alternative treatments should be considered early in patients on long-term thiamazole therapy.
• Plasmapheresis presents a viable therapeutic option for rapidly normalizing thyroid hormone levels in cases of severe thyrotoxicosis and agranulocytosis.