Clinical characteristics of antithyroid drug-induced aplastic anemia cases over the past 30 years

OBJECTIVE

The authors aimed to investigate the clinical characteristics of antithyroid drug-induced aplastic anemia cases over the past 30 years.

METHODS

The data of patients with antithyroid drug-induced aplastic anemia were retrieved from PubMed and Wanfang Medical Network databases from 1992 to August 2022. The clinical characteristics, such as age distribution, gender tendency, common symptoms, blood cell count, bone marrow features, treatment strategy, and prognosis, were analyzed.

RESULTS

A total of 17 cases (male:female = 1:16) had been retrieved. Patients' age ranged from 16 to 74 years (median 50 years). Among them, 82.3% (14/17) of the patients were administered methimazole (MMI), and 78.6% of them had MMI ≥30 mg/day. In addition, 88.2% (15/17) of the patients had sore throat and fever, and 47.1% (8/17) of the patients had hemorrhagic symptoms. Aplastic anemia occurred within 6 months after initiation of the antithyroid therapy in 94.1% of the patients. Agranulocytosis (94.1%) was the most common and earliest blood cell change, and 47.1% of the patients experienced progressive platelet decline during the treatment process. The treatments include timely withdrawal of antithyroid drugs, broad-spectrum antibiotics, granulocyte colony-stimulating factor (G-CSF)/granulocyte-macrophage colony-stimulating factor (GM-CSF), glucocorticoids and other immunosuppressive agents, and supportive treatments such as erythrocyte transfusion and platelet transfusion. Moreover, 70.6% of the patients had complete or near-complete remission within 8 days to 6 weeks.

CONCLUSION

Aplastic anemia is a rare and serious adverse reaction of antithyroid drugs, which is more common in women. It usually occurs during early treatment with high-dose antithyroid drugs. Most patients have a good prognosis after timely drug ceasing and appropriate treatment.

An overview of the hematological picture with antithyroid therapy in Graves' disease

Aim: Graves' disease is an autoimmune thyroid disease that is the most common cause of hyperthyroidism. Peripheral blood cell parameters such as neutrophils, lymphocytes, and platelets play a role in inflammation control. Several studies have proven that neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio and platelet-lymphocyte ratio are indicators of chronic subclinical inflammation in various diseases. In our study, we aimed to review the peripheral blood picture by evaluating these parameters before and after antithyroid treatment in patients with Graves' disease. Patients and methods: A total of 120 patients (93 female, 27 male) between the ages of 18-65 were included. Demographic data, hemogram and biochemical data of the patients were recorded retrospectively at the time of diagnosis and after euthyroidism was achieved with medical treatment. Results: During the treatment, there was an increase in hemoglobin, lymphocytes, neutrophils and red cell distribution width, while a decrease in monocytes was observed. There was no significant difference between white blood cell, platelet and mean platelet volume. In addition, while there was no statistically significant difference between neutrophil-lymphocyte ratio (p = 0.8) and thrombocyt-lymphocyte ratio (p = 0.078) after euthyroid state, a statistically significant difference was found in favor of a decrease in monocyte-lymphocyte ratio (p = 0.006). Conclusion: Changes in hematopoiesis are relatively common in patients with newly diagnosed Graves' disease, and initiation of antithyroid therapy leads to improvement in these parameters. Although neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio and platelet-lymphocyte ratio are accepted as new, non-invasive markers in clinical evaluation, in our study only a significant decrease in monocyte-lymphocyte ratio levels was observed after euthyroidism was achieved with antithyroid treatment.