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Two Cases of Methimazole-Induced Agranulocytosis With Their Risk Factors
Aye Khine1, Kiranjit Dhillon1, Linda Jo1
1Department of Internal Medicine, University of California San Francisco-Fresno, Fresno, California.
AACE Clinical Case Reports
|April 13, 2022
Summary
Methimazole (MMI) can cause agranulocytosis, a dangerous drop in white blood cells. Older women on higher MMI doses face increased risk. Awareness and monitoring are key to preventing severe outcomes.
Area of Science:
- Endocrinology
- Pharmacology
- Hematology
Background:
- Antithyroid drugs like methimazole (MMI) are standard for thyrotoxicosis treatment.
- Agranulocytosis is a rare but potentially fatal adverse effect of antithyroid medications.
- This report details two cases of MMI-induced agranulocytosis with shared risk factors.
Observation:
- Case 1: A 71-year-old woman with Graves disease developed neutropenic fever due to MMI. Treatment with filgrastim led to recovery.
- Case 2: A 68-year-old woman with Graves disease experienced septic shock from MMI-induced agranulocytosis, complicated by pneumonia and bacteremia. Despite aggressive treatment, she died.
Findings:
- Both patients were older females with Graves disease.
- Higher doses of MMI were administered to both patients.
- Similar risk factors, including advanced age, female sex, and elevated MMI dosage, predisposed these patients to agranulocytosis.
Implications:
- Awareness of risk factors such as age, sex, and MMI dose is crucial for early detection.
- Close patient monitoring can mitigate the risk of severe MMI-induced agranulocytosis.
- Prompt management, including MMI discontinuation and supportive care, is essential for improving patient outcomes.
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