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Methimazole treatment of hyperthyroidism induced neutropenia deficiency five cases

Author: MengQingFang From: www.yourpaper.net Posted: 2010-06-24 11:18:29 Read:
[Keyword] thyroid hyperthyroidism; agranulocytosis; thiamazole
Methimazole (MMI) is a commonly used clinical anti-thyroid drugs. Hyperthyroidism MMI medication, some can cause patients with neutropenia, agranulocytosis serious toxicity even endanger the patient's life. The diagnostic criteria in accordance with agranulocytosis, from 2007 to 2008 in our hospital, five cases of MMI-induced agranulocytosis clinical data of the patients reported as follows.
1 Clinical data and methods
1.1 General Information
5 cases were female patients with hyperthyroidism, age 32 to 65 years, no history of allergy. Before admission herein are MMI treatment dose of 15 to 30 mg / d orally 3 times the medication 20 to 200 d. 3 patients have high fever, fatigue, sore throat, chills, and varying degrees of enlarged tonsils purulent. Peripheral blood shows WBC count <3.0 x 109 / L, absolute neutrophil count two cases 0,3 cases <0.3 กม 109 / L.
1.2 The diagnostic criteria
(1) diagnosis of patients with Graves' disease, there are clearly taking methimazole drug history. (2) peripheral blood granulocytes absolute value <0.5 กม 109 / L, hemoglobin, platelet generally normal. (3) except for other causes of agranulocytosis.
1.3 Treatment
After admission herein are single room disinfection and isolation, PP powder bath, Dobell's mouthwash, antibiotic therapy, elevated white blood cell therapy.
2 results
The treatment did not occur during other adverse reactions. 7 to 15 days after hospitalization, the admission of the first symptoms disappeared, the agranulocytosis cure.
discussion
3.1 MMI cause neutropenia incidence and pathogenesis of MMI because of its good efficacy of antithyroid effect is widely used in the treatment of hyperthyroidism. However, MMI can cause neutropenia, the latter is a serious complication of MMI therapy. MMI-induced neutropenia can occur several hours to several years after taking the MMI, but most occurred within 3 months after taking, especially after taking 3 to 4 weeks, the incidence of 0.1% [1]. MMI cause neutropenia pathogenesis mainly include two aspects: 1 MMI bone marrow suppression DNA synthesis and mitosis reduce myeloid cause neutropenia. The MMI as a hapten and the body white blood cells to form complete antigen to stimulate the body to produce white blood cell antibodies - haemagluttinin, attached to the surface of granulocytes, granulocyte aggregation caused damage.
3.2 MMI cause neutropenia-saving treatment
3.2.1 disable MMI
Granulocytes damage caused by the immune mechanism, MMI is an important mechanism to cause neutropenia. Disable MMI, remove the cause, the granulocytes may resume. 5 patients, once diagnosed, immediately disabled the MMI, and lay the foundation to obtain good effect after other treatments. 3.2.2 anti-infection treatment efforts to a large
Neutropenia extremely severe sepsis, which is mainly due to neutropenic patients died, even in the effective use of antibiotics, the mortality rate was as high as 25% [2]. MMI cause neutropenia or white blood cells are not immediate, neutropenia state generally last from one to several days, with some patients on admission have severe infections, so early strong anti-infection treatment caused the MMI is very important in the treatment of neutropenia . Currently considered neutropenia Once the diagnosis should be early use broad-spectrum antibiotics for treatment, and three patients selected cefoperazone - sulbactam (where forest) treatment. It is noteworthy that the strong antibiotic treatment for too long, pay attention to the occurrence of superinfection.
3.2.3 or white blood cells in the treatment of stronger
5 patients the Burnet rose white film and recombinant human granulocyte colony-stimulating factor 1 to 7 d after neutrophil recovery to normal. Dose of recombinant human granulocyte colony-stimulating factor, patients 2 to 5 microg / (kg - d) to obtain good effect, critically ill patients should be appropriate to increase the amount of patients to approximately 5.5 microg / (kg - d), No adverse reactions.
3.2.4 beta-receptor blockers
Propranolol can inhibit thyroid hormone on the role of the sympathetic nervous system, also can reduce the speed of the peripheral conversion of T4 to T3. The presence of bronchial disease patients can choose selective receptor blockers, such as metoprolol.
3.2.5 Other treatment measures are also in place
Live in isolation wards, good personal hygiene in salvage therapy MMI caused the grain shortage has an important role in the process of patients. In addition, patients with hyperthyroidism after discontinuation of MMI, the choice of surgical treatment or isotope therapy, generally after neutropenia recovery operation [3]. Hyperthyroid condition should be observed in the course of treatment of neutropenia, pay attention to the prevention and treatment of thyroid crisis.
In short, the MMI induced myeloid deficiency is a rare and dangerous adverse reactions, unpredictable, neutropenia occurred within 2 months of the start of drug treatment of patients with hyperthyroidism, should be highly vigilant, taking antithyroid drugs should be routine monitoring of peripheral blood leukocytes for early detection of patients with agranulocytosis.
[References]
[1] Wolff J.Perchlorate and the thyroid gland [J]. Pharmacologi-cal Reviews, 1998,50:89.

[2] Li Quan Zou Ping thiamazole induced agranulocytosis co-infection the four clinical analysis [J]. Clinical Internal Medicine, 2006, 23 (4): 281.

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