Thyroidectomy for the treatment of Graves’ thyrotoxicosis in thioamide-induced agranulocytosis and sepsis

[摘要] A 51 year old man presented with sepsis in the setting of thioamide-induced agranulocytosis. Empiric broad-spectrumantibiotics was followed by directed narrow-spectrum antibiotics, and his neutrophil count recovered with support fromgranulocyte-colony stimulating factor (G-CSF) analogue transfusions. After a brief period of multi-modal therapy fornine days including potassium iodide (Lugol’s iodine), cholestyramine, propanolol and lithium to temper his persistinghyperthyroidism, a total thyroidectomy was performed while thyroid hormone levels remained at thyrotoxic levels.Postoperative recovery was uncomplicated and he was discharged home on thyroxine. There is limited available evidenceto guide treatment in this unique cohort of patients who require prompt management to avert impending clinicaldeterioration. This case report summarises the successful emergent control of thyrotoxicosis in the setting of thioamideinduced agranulocytosis complicated by sepsis, and demonstrates the safe use of multi-modal pharmacological therapiesin preparation for total thyroidectomy.

[学科分类] 血液学