Analysis of Antithyroid Drug-Induced Severe Liver Injury in 18,558 Newly Diagnosed Patients with Graves’ Disease in Japan

Background: There are limited data about the factors affecting the response time to medical treatment in Graves’ disease (GD) although many studies examined the predictors of the relapse after drug withdrawal. The aim of the current study was to evaluate the time for becoming euthyroid under antithyroid drug (ATD) therapy and the parameters influencing this period in patients diagnosed as GD.Methods: Patients with newly-diagnosed GD and decided to treat with ATD initially between March 2017 and September 2018 were retrieved retrospectively. Sociodemographic features as well as laboratory parameters like thyroid function tests and thyroid-stimulating hormone-receptor antibody (TRab) at the time of diagnosis were recorded.Results: Out of 41 patients, 63.4% (n=26) were female. The mean age was 36.1±11.7 years and 43.9% (n=18) of them were smoking. The time between the initiation of treatment and the duration of becoming euthyroid was 2.4±1.8 months. No significant difference was noted between age, gender, and smoking status and the time to become euthyroid under ATD treatment. This period was significantly positively correlated with levels of free triiodothyronine, free thyroxine, and negatively correlated with thyroid-stimulating hormone. Response to ATD therapy was higher in patients with pre-treatment TRab levels <10 IU/l than TRab ≥10 IU/l (p=0.011).Conclusions: Pretreatment thyroid function tests and TRab levels may be taken into consideration before deciding treatment in patients with newly diagnosed GD. It would be useful to design more comprehensive studies so that this proposal can find a response in clinical practice.

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Serum Immunogllobulin G Levels in Graves’ disease Patients at Various Stages of Antithyroid Therapy

Annals of King Edward Medical University ◽

10.21649/akemu.v8i1.1627 ◽

2017 ◽

Vol 8 (1) ◽

Author(s):

N Kousar ◽

M Tayyab ◽

A Ditta ◽

F Kamal ◽

SN Chaudhary

Keyword(s):

Drug Therapy ◽

Therapy Group ◽

Antithyroid Drug ◽

Graves Disease ◽

Newly Diagnosed ◽

Antithyroid Drug Therapy ◽

Group A ◽

The Mean ◽

Group B ◽

Normal Controls

Thirty six patients with Graves’ disease (GD), diagnosed on the basis of clinical examination and appropriate laboratory tests were classified into three groups (A-C): Group A: twelve newly diagnosed Graves’ disease patients; Group B: twelve hyperthyroid Graves’ disease patients on Antithyroid drug therapy and Group C: twelve Graves’ disease patients who had been rendered cuthyroid with Antithyroid drug (ATD) therapy, Serum lgG was determined by radial immunodiffusion method using commercially available kits (The Binding Site UK). The mean lgG in newly diagnosed patients with GD (Group A) was 18.78±1.81. It was 22.75 ± 1.89 in hyperthyroid GD patients on drug therapy (Group B), 14.3±0.8 in GD patients who were rendered euthyroid with drug therapy (Group C) and 11.85±0.72 in normal controls. The lgG level of group A patients were not significantly different from those of Group B. However, the levels of lgG and lgA were significantly low in group C Graves’ disease patients as compared to group A patients. A significant reduction in lgG LEVEL IN Graves’ disease patients who were rendered cuthyroid after Antithyroid drug therapy as compared to newly diagnosed Graves’ disease patients indicate the immunosuppressive effect of Antithyroid drug therapy.

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Graves Disease Causing Pancytopenia: Case Report and Literature Review

Clinical Medicine Insights Case Reports ◽

10.1177/1179547618781090 ◽

2018 ◽

Vol 11 ◽

pp. 117954761878109 ◽

Cited By ~ 2

Author(s):

Laurence Pincet ◽

François Gorostidi

Keyword(s):

Literature Review ◽

Rare Complication ◽

Hematopoietic Cells ◽

Cell Lineage ◽

Antithyroid Drug ◽

Graves Disease ◽

Newly Diagnosed ◽

Case Presentation ◽

Euthyroid State ◽

Antithyroid Drug Therapy

Background: Graves disease or other causes of thyrotoxicosis are frequently associated with cytopenia. Although anemia is the most common, other cell lineage can be affected. Pancytopenia is a rare complication of thyrotoxicosis. Case presentation: We report a case of a 33-year-old Chinese man who presented a nonsevere pancytopenia in the context of a newly diagnosed Graves disease. Restauration of euthyroid state led to progressive correction of pancytopenia. Conclusions: Literature review shows other rare cases of pancytopenia. It is usually nonsevere with just extremely rare cases of transfusion reported. Evolution was always favorable after achievement of euthyroid state. Its mechanism remains poorly understood, especially because those patients have no vitamin or iron deficiency. The exact physiopathological process remains unclear but 2 causes seem to overlap: reduced production of hematopoietic cells from the bone marrow and increased destruction or sequestration of mature hematopoietic cells. Despite unclear mechanism, the presence of hematologic abnormalities including pancytopenia must not be considered as a contraindication to antithyroid drug therapy.

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A Case of Antithyroid Drug-Induced Agranulocytosis Pre-Covid 19 Era

10.52916/jmrs204031 ◽

2020 ◽

pp. 1-4

Author(s):

MosabNouraldein Mohammed Hamad

Keyword(s):

Side Effects ◽

Neutrophil Count ◽

Antithyroid Drug ◽

Drug Effects ◽

Medical Advice ◽

Antithyroid Drugs ◽

Graves Disease ◽

Drug Induced ◽

Immunological Mechanisms ◽

Noticeable Reduction

Agranulocytosis is an infrequent and serious side effect of antithyroid drugs characterized by a noticeable reduction in granulocyte and neutrophil count, it usually occurs within the first 2-3 months of treatment. There is a variety of mechanisms by which ATD can induce agranulocytosis, direct drug effects, and immunological mechanisms. We present 33 years old female attended Atbara teaching hospital who has developed agranulocytosis 2 weeks after starting ATD to treat relapsed Graves' disease. What was unusual about this patient is that symptoms have occurred in a period less than 15 days of starting treatment and with a dose of 45 mg /day. The physician must educate the patient about the possibility of early onset of serious side effects of ATD and to seek medical advice as soon as possible.

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Frequency of Adverse Events of Antithyroid Drugs Administered during Pregnancy

Journal of Thyroid Research ◽

10.1155/2014/952352 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Ai Yoshihara ◽

Jaeduk Yoshimura Noh ◽

Natsuko Watanabe ◽

Kenji Iwaku ◽

Sakiko Kobayashi ◽

...

Keyword(s):

Adverse Events ◽

Pregnant Women ◽

Antithyroid Drug ◽

Antithyroid Drugs ◽

Graves Disease ◽

Newly Diagnosed ◽

Cutaneous Reactions ◽

First Time

The frequency and types of adverse events after initial antithyroid drug (ATD) therapy during pregnancy have never been reported, nor has whether the frequency of adverse events is the same as among nonpregnant subjects ever been investigated. We investigated retrospectively the frequency of adverse events after initial ATD administration to previously untreated Graves’ disease (GD) patients during pregnancy. We reviewed the charts of cases of 91 untreated pregnant women who came to our hospital for the first time and were newly diagnosed with GD during the period between January 1, 1999, and December 31, 2011. Thiamazole (MMI) was used to treat 40 patients and 51 patients were treated with propylthiouracil (PTU). Adverse events occurred in 5 patients (5/40; 12.5%) treated with MMI, and they consisted of cutaneous reactions in 5 patients. Adverse events occurred in five patients (5/51; 9.8%) treated with PTU, and they consisted of hepatotoxicity in two patients and cutaneous reactions in three patients. No patients experienced agranulocytosis or ANCA-related vasculitis. Comparison with the expected rate of adverse events in nonpregnant individuals showed that the frequency of adverse events in pregnant individuals was low.

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