title: Elevated serum granulocyte colony-stimulating factor levels in patients with Graves' disease.
abstract: OBJECTIVE
  Agranulocytosis is a serious side effect of anti-thyroid drugs (ATD). Granulocyte colony-stimulating factor (G-CSF) is one of the cytokines that increase granulocyte number. The aim of this study was to examine the sequential variation of serum G-CSF levels in patients with Graves' disease before and after ATD therapy.
  
  
  METHODS
  Sixty-three patients with Graves' disease were studied before, during and after treatment with methimazole (MMI). Serum samples from 71 healthy subjects were used as controls.
  
  
  METHODS
  Serum levels of G-CSF were measured by a novel chemiluminescent enzyme immunoassay, which was sensitive enough to determine G-CSF levels in healthy subjects. Blood granulocyte counts, serum, thyroid hormone and TSH levels, and titres of thyroid autoantibodies were also measured.
  
  
  RESULTS
  Serum G-CSF levels in Graves' patients before and 2 weeks after MMI were significantly higher than in healthy subjects. There was a significant correlation between serum G-CSF levels and granulocyte counts in untreated patients with Graves' disease. Untreated patients with granulocyte counts less than 2 x 10(9)/I had significantly lower serum G-CSF levels as compared with other untreated patients. Serum G-CSF levels gradually decreased thereafter. No correlation was observed between serum G-CSF levels and serum thyroid hormone levels or titres of thyroid autoantibodies. After ATD treatment, no correlation was found between serum G-CSF levels and granulocytes counts. There was no significant correlation between the change of serum G-CSF levels and that of granulocyte counts before and after MMI treatment. Graves' patients with mild agranulocytosis had normal or elevated serum G-CSF levels.
  
  
  CONCLUSIONS
  Significantly elevated serum G-CSF levels were observed in patients with Graves' hyperthyroidism. During ATD therapy, deficiency of G-CSF was not identified as a cause of agranulocytosis in this study.
authors.affiliation: Department of Internal Medicine 4, Saitama Medical School, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Iitaka
authors.forename: J Y
authors.initials: JY
authors.lastname: Noh
authors.forename: S
authors.initials: S
authors.lastname: Kitahama
authors.forename: N
authors.initials: N
authors.lastname: Fukasawa
authors.forename: S
authors.initials: S
authors.lastname: Miura
authors.forename: Y
authors.initials: Y
authors.lastname: Kawakami
authors.forename: S
authors.initials: S
authors.lastname: Kawasaki
authors.forename: K
authors.initials: K
authors.lastname: Yamanaka
authors.forename: J
authors.initials: J
authors.lastname: Ishii
authors.forename: S
authors.initials: S
authors.lastname: Katayama
authors.forename: K
authors.initials: K
authors.lastname: Ito
mesh_terms: D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood*; D006098:Granulocytes / Q000378:metabolism; D006111:Graves Disease / Q000097:blood* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007124:Immunoenzyme Techniques; D007958:Leukocyte Count; D008163:Luminescent Measurements; D008297:Male; D008713:Methimazole / Q000627:therapeutic use*; D008875:Middle Aged; D013963:Thyroid Hormones / Q000097:blood
chemical_list: D013956:Antithyroid Agents; D001323:Autoantibodies; D013963:Thyroid Hormones; D016179:Granulocyte Colony-Stimulating Factor; D008713:Methimazole