title: Characteristics of Antithyroid Drug-Induced Agranulocytosis in Patients with Hyperthyroidism: A Retrospective Analysis of 114 Cases in a Single Institution in China Involving 9690 Patients Referred for Radioiodine Treatment Over 15 Years.
abstract: Antithyroid drug (ATD)-induced agranulocytosis is a rare but life-threatening disease. Clinical features of ATD-induced agranulocytosis and outcomes remain incompletely understood.
  
  
  
  Patients with clinically diagnosed ATD-induced agranulocytosis were retrospectively studied, involving 9690 patients who were referred for radioiodine treatment during a 15-year period (2000-2015) in China. There were 114 cases of agranulocytosis attributable to ATD included, and their clinical characteristics and therapy outcomes were analyzed.
  
  
  
  The female-to-male ratio of ATD-induced agranulocytosis was 10.4:1. The mean age (±standard deviation) of the patients with ATD-induced agranulocytosis was 41.7 ± 12.3 years. The methimazole and propylthiouracil doses given at the onset were 22.9 ± 8.0 mg/day and 253.6 ± 177.5 mg/day, respectively. ATD-induced agranulocytosis occurred in 45.1%, 74.3%, and 88.5% of patients within 4, 8, and 12 weeks of the onset of ATD therapy, respectively. Fever (78.9%) and sore throat (72.8%) were the most common symptoms when agranulocytosis was diagnosed. The mean recovery time of agranulocytosis was 13.41 ± 7.14 days. Recovery time in the granulocyte colony-stimulating factor (G-CSF)-treated group (12.7 ± 6.0 days) did not differ from that in the group not treated with G-CSF (16.4 ± 10.6 days; p = 0.144). Treatment with (131)I was successful in 87/98 patients (88.8%). The success rate of (131)I was equivalent (p = 1.000) between the groups receiving methimazole (88.2%, 75/85) and propylthiouracil (92.3%, 12/13).
  
  
  
  This largest single-institution study in China shows that ATD-induced agranulocytosis tends to occur within the first 12 weeks after the onset of ATD therapy. For patients with ATD-induced agranulocytosis, G-CSF does not improve the recovery time of agranulocytosis, and (131)I is an optimal treatment approach.
authors: 1 Department of Nuclear Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, People's Republic of China .
authors: Jun
authors: J
authors: Yang
authors: 1 Department of Nuclear Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, People's Republic of China .
authors: Yang-Jun
authors: YJ
authors: Zhu
authors: 2 Department of Nuclear Medicine, Taizhou Central Hospital , Taizhou, People's Republic of China .
authors: Ji-Jun
authors: JJ
authors: Zhong
authors: 1 Department of Nuclear Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, People's Republic of China .
authors: Jun
authors: J
authors: Zhang
authors: 1 Department of Nuclear Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, People's Republic of China .
authors: Wan-Wen
authors: WW
authors: Weng
authors: 3 PET Center, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, People's Republic of China .
authors: Zhen-Feng
authors: ZF
authors: Liu
authors: 1 Department of Nuclear Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, People's Republic of China .
authors: Qin
authors: Q
authors: Xu
authors: 1 Department of Nuclear Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, People's Republic of China .
authors: Meng-Jie
authors: MJ
authors: Dong
mesh_terms: D000328:Adult; D000380:Agranulocytosis / Q000139:chemically induced* / Q000188:drug therapy; D013956:Antithyroid Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002681:China; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy*; D008297:Male; D008713:Methimazole / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D011441:Propylthiouracil / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D016179:Granulocyte Colony-Stimulating Factor; D008713:Methimazole; D011441:Propylthiouracil