title: Propylthiouracil induced C-ANCA positive agranulocytosis complicating Graves' thyrotoxicosis in pregnancy.
abstract: BACKGROUND
  Thionamide induced agranulocytosis is associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA) in some patients. This poses a particular challenge when it occurs during pregnancy.
  
  
  OBJECTIVE
  To report a case of a 31-year-old woman with Graves' disease who presented at 11 weeks gestation with propylthiouracil induced agranulocytosis.
  
  
  METHODS
  After cessation of propylthiouracil the patient developed recurrent thyrotoxicosis, and underwent an elective subtotal thyroidectomy at 23 weeks gestation.
  
  
  RESULTS
  The patient required postoperative thyroxine replacement therapy. Subsequent pregnancy was uneventful and she delivered a healthy baby boy at 41 weeks gestation. As part of our routine work up for agranulocytosis we measured C-ANCA levels, which were significantly elevated.
  
  
  CONCLUSIONS
  This case highlights the association of propylthiouracil induced ANCA positivity and agranulocytosis. Second trimester subtotal thyroidectomy was safe and effective in treating this pregnant patient's thyrotoxicosis.
authors.affiliation: Department of Endocrinology and Diabetes Mellitus, Mater Misericordiae Hospital, Eccles' Street, Dublin 7, Ireland.
authors.forename: F M
authors.initials: FM
authors.lastname: Finucane
authors.forename: J
authors.initials: J
authors.lastname: O'Connell
authors.forename: B T
authors.initials: BT
authors.lastname: Kinsley
mesh_terms: D000328:Adult; D000380:Agranulocytosis / Q000097:blood / Q000139:chemically induced*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D013956:Antithyroid Agents / Q000009:adverse effects*; D005260:Female; D006111:Graves Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D011441:Propylthiouracil / Q000009:adverse effects*; D047929:Term Birth; D013965:Thyroidectomy; D013971:Thyrotoxicosis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D011441:Propylthiouracil