title: Antithyroid drugs induced agranulocytosis and multiple myeloma: case report and general considerations.
abstract: Antithyroid drugs as thionamides are largely used in the treatment of the thyrotoxicosis. Side effects were reported in less than 10% of the cases, especially hematological, hepatic or skin allergies. One of the most severe manifestations is agranulocytosis, probably based on an immune mechanism that is exacerbated by the presence of the thyroid autoimmune disease itself. If the presence of the severe leucopenia is actually an epiphenomenon of a preexisting hematological disturbance as multiple myeloma is debated. The myeloma may also be correlated with an autoimmune predisposition. We present the case of a 56 years old female patient diagnosed with Graves' disease, who developed agranulocytosis after 8 months of therapy with thiamazole. Two months after antithyroid drug's withdrawal, the granulocytes number increased and she received therapy with radioiodine. Two years later she came back for diffuse bone pain that turned out to be caused by a multiple myeloma, confirmed by bone marrow biopsy. It might be a connection between the severe form of leucopenia that the patient developed and the medullar malignancy.
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Dănciulescu Miulescu
authors.forename: M
authors.initials: M
authors.lastname: Carşote
authors.forename: R
authors.initials: R
authors.lastname: Trifănescu
authors.forename: D
authors.initials: D
authors.lastname: Ferechide
authors.forename: C
authors.initials: C
authors.lastname: Poiană
mesh_terms: D000380:Agranulocytosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000276:immunology; D013956:Antithyroid Agents / Q000009:adverse effects*; D015551:Autoimmunity / Q000187:drug effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000276:immunology; D010014:Osteolysis / Q000150:complications / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D013956:Antithyroid Agents
keywords: Graves’ disease; agranulocytosis; multiple myeloma; thiamazole