title: Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole-induced agranulocytosis.
abstract: OBJECTIVE
  To report a case of a patient with Graves disease presenting with agranulocytosis induced by methimazole, with subsequent thyroid storm and successful therapeutic use of plasmapheresis.
  
  
  METHODS
  The clinical features and laboratory findings in a patient with agranulocytosis and thyroid storm are presented, and the available literature on utilization of plasmapheresis in the setting of thyrotoxicosis is reviewed.
  
  
  RESULTS
  A 40-year-old Vietnamese woman with Graves disease was admitted with methimazole-induced agranulocytosis. Treatment with methimazole was discontinued, and therapy with antibiotics, granulocyte colony-stimulating factor, and ibuprofen was initiated. During hospitalization of the patient, her clinical status deteriorated, with development of pericarditis, thrombocytopenia, and thyroid storm. Treatment with plasmapheresis yielded near-euthyroidism in 3 days. Subsequently, she underwent successful total thyroidectomy.
  
  
  CONCLUSIONS
  Our case highlights the effectiveness of plasmapheresis when clinical situations prohibit the use of traditional treatment methods for thyrotoxicosis or thyroid storm (or both).
authors.affiliation: Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
authors.forename: Ashish A
authors.initials: AA
authors.lastname: Vyas
authors.forename: Priyanka
authors.initials: P
authors.lastname: Vyas
authors.forename: Nicole Lynn
authors.initials: NL
authors.lastname: Fillipon
authors.forename: Rajakrishnan
authors.initials: R
authors.lastname: Vijayakrishnan
authors.forename: Nitin
authors.initials: N
authors.lastname: Trivedi
mesh_terms: D000328:Adult; D000380:Agranulocytosis / Q000139:chemically induced / Q000150:complications* / Q000276:immunology; D013956:Antithyroid Agents / Q000009:adverse effects*; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D008713:Methimazole / Q000009:adverse effects*; D010956:Plasmapheresis; D013958:Thyroid Crisis / Q000150:complications* / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D013965:Thyroidectomy; D013971:Thyrotoxicosis / Q000276:immunology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D008713:Methimazole