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Methimazole-Induced Pancytopenia in a Patient with Graves' Disease: A Case Report and Literature Review
Marcio José Concepción-Zavaleta1, Juan Eduardo Quiroz-Aldave2, Katia Eugenia Rivera Fabián3
1Universidad Científica del Sur. Lima, Perú.
Introduction:
Methimazole is an antithyroid drug known to cause hematological toxicity, including agranulocytosis and, very rarely, pancytopenia. We herein present a case of a patient with Graves' Disease (GD) who developed methimazole-induced pancytopenia.
Case Report:
A 53-year-old Peruvian woman with GD, initially treated with methimazole 20 mg BID, experienced odynophagia, fever, and malaise after 37 days of treatment. The initial diagnosis was agranulocytosis, leading to the discontinuation of methimazole and initiation of antibiotics. Due to persistent neutropenia, a Granulocyte Colony-stimulating Factor (G-CSF) was administered. Eight days later, she developed pancytopenia and was managed with hematopoietic agents and platelet transfusions. The patient recovered with normalization of the blood count, eliminating the need for Bone Marrow (BM) examination. Radioiodine therapy was chosen as the definitive treatment, resulting in hypothyroidism. Currently, the patient is thyroidal and hematologically stable.
Conclusion:
Methimazole-induced pancytopenia is a rare and serious complication; however, with appropriate treatment, complete recovery can be achieved.
Insights
Methimazole, an antithyroid drug, can rarely cause pancytopenia, a serious blood disorder. This case highlights that prompt treatment can lead to complete recovery from this rare complication.
Area of Science:
- Endocrinology
- Hematology
Background:
- Methimazole is a common antithyroid medication used for Graves' Disease.
- Hematological toxicity, including agranulocytosis and pancytopenia, are known side effects.
Observation:
- A 53-year-old woman with Graves' Disease developed severe hematological toxicity after 37 days of methimazole treatment.
- Initial symptoms included odynophagia, fever, and malaise, progressing to pancytopenia despite treatment for agranulocytosis.
Findings:
- The patient experienced methimazole-induced pancytopenia, a rare but serious adverse effect.
- Treatment with G-CSF, hematopoietic agents, and platelet transfusions led to complete blood count normalization.
- Radioiodine therapy was successfully used for definitive Graves' Disease management.
Implications:
- This case underscores the importance of monitoring for rare hematological complications of methimazole.
- Early recognition and appropriate management can lead to favorable outcomes in methimazole-induced pancytopenia.
- Physicians should consider alternative treatments like radioiodine therapy for Graves' Disease when methimazole toxicity is suspected.
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