title: Emphasis on the early diagnosis of antithyroid drug-induced agranulocytosis: retrospective analysis over 16 years at one Chinese center.
abstract: OBJECTIVE
  Antithyroid drug (ATD)-induced agranulocytosis is a rare but life-threatening adverse drug reaction that occurs in patients during the treatment of Graves' disease. We aimed to comprehensively examine data for patients with this rare complication and to improve the clinical safety of ATDs.
  
  
  METHODS
  We retrospectively reviewed the medical records of 64 hospitalized patients diagnosed with ATD-induced agranulocytosis between 2000 and 2015.
  
  
  RESULTS
  Agranulocytosis occurred in 52 (81.3%) patients within the first 3 months after initiation of ATD therapy. Fever (84.4%) and sore throat (82.8%) were the most common symptoms. Although they experienced symptoms, 30 (46.9%) patients did not seek treatment immediately and delayed their diagnosis of agranulocytosis. The minimum granulocyte count was lower in the patients diagnosed after the appearance of symptoms than in those diagnosed before the appearance of symptoms (0.01 × 109/L (0 × 109/L - 0.06 × 109/L) versus 0.26 × 109/L (0.05 × 109/L - 0.40 × 109/L), P < 0.001). The interval days from the appearance of symptoms to the diagnosis of agranulocytosis were negatively correlated with the minimum granulocyte count (r = -0.348, P = 0.005). In addition, a lower minimum granulocyte count was associated with a longer recovery time (β = -11.899, 95% CI -15.304 to -8.496).
  
  
  CONCLUSIONS
  Our findings have demonstrated that delayed diagnosis of ATD-induced agranulocytosis is common in our population. Delayed diagnosis is associated with severe agranulocytosis and may prolong the recovery time from agranulocytosis. Monitoring of the white blood cell and granulocyte counts may be an effective way to establish an early diagnosis and prevent progression to severe agranulocytosis.
authors.affiliation: Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710061, Shaanxi, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Rheumatology, The Fifth Hospital of Xi'an, Xi'an, Shaanxi, People's Republic of China.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, People's Republic of China.
authors.forename: J
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710061, Shaanxi, People's Republic of China.
authors.forename: Z
authors.initials: Z
authors.lastname: Khan
authors.affiliation: Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710061, Shaanxi, People's Republic of China.
authors.forename: W
authors.initials: W
authors.lastname: Qiang
authors.affiliation: Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, People's Republic of China.
authors.forename: F
authors.initials: F
authors.lastname: Gao
authors.affiliation: Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710061, Shaanxi, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710061, Shaanxi, People's Republic of China. shibingy@126.com.
authors.forename: B
authors.initials: B
authors.lastname: Shi
mesh_terms: D000328:Adult; D000380:Agranulocytosis / Q000139:chemically induced / Q000175:diagnosis*; D013956:Antithyroid Agents / Q000009:adverse effects*; D044466:Asian People; D042241:Early Diagnosis; D005260:Female; D006111:Graves Disease / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008713:Methimazole / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D013956:Antithyroid Agents; D008713:Methimazole
keywords: Agranulocytosis; Antithyroid drug; Graves’ disease; Hyperthyroidism