Carbimazole induced agranulocytosis with hypothyriodism – a case report
Journal name: World Journal of Pharmaceutical Research
Original article title: Carbimazole induced agranulocytosis with hypothyriodism – a case report
The WJPR includes peer-reviewed publications such as scientific research papers, reports, review articles, company news, thesis reports and case studies in areas of Biology, Pharmaceutical industries and Chemical technology while incorporating ancient fields of knowledge such combining Ayurveda with scientific data.
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Summary of article contents:
1. Introduction
Agranulocytosis, a serious and rare adverse effect associated with the use of antithyroid drugs, occurs in approximately 0.17% to 0.23% of patients. Antithyroid medications such as Carbimazole, Propylthiouracil, and Methimazole have been linked to this condition, which can present as a life-threatening emergency. Increased risks of agranulocytosis are observed in females and older patients. Patients using these drugs must be vigilant for symptoms such as fever or sore throat and should seek immediate medical attention if these occur, given the potentially fatal nature of this complication.
2. Carbimazole and Agranulocytosis: A Serious Risk
Carbimazole is one of the most commonly prescribed antithyroid drugs for treating hyperthyroidism. Despite its effectiveness, it has been associated with an increased incidence of agranulocytosis, especially within the first 90 days of treatment, although cases have been reported even after one year of usage. The hematological dysfunction it causes can lead to profound reductions in granulocytes, putting patients at significant risk of infections. The mortality rate associated with drug-induced agranulocytosis is alarmingly high at approximately 21.5%, underscoring the need for careful monitoring and patient education.
3. Case Presentation and Clinical Insights
In a documented case, a 38-year-old female with a history of hyperthyroidism was admitted with severe symptoms, including general weakness, sore throat, and low blood pressure. Upon investigation, laboratory tests revealed low white cell and hemoglobin counts, indicating agranulocytosis likely induced by her prolonged use of Carbimazole. Following her condition, Carbimazole was discontinued, and she received symptomatic treatment. The case emphasizes the importance of recognizing clinical features of agranulocytosis and the potential relationship with chronic antithyroid drug use.
4. Management and Monitoring
Managing drug-induced agranulocytosis requires immediate cessation of the offending medication, supportive care, and possibly antibiotic treatment for any secondary infections. Patients should be educated about the signs of agranulocytosis, so they can act quickly if symptoms develop. Regular monitoring of blood counts could be considered; however, due to the rapid onset and potentially explosive nature of agranulocytosis, routine assessments may not be effective in preventing this serious complication. The decision to monitor should be individualized based on the patient's risk profile and treatment plan.
5. Conclusion
Agranulocytosis presents a significant risk to individuals taking Carbimazole and other antithyroid medications. Prompt identification and management of this complication are crucial for patient safety. Given its severe implications, awareness among both healthcare providers and patients about the risks associated with antithyroid drugs is vital. Continued vigilance for symptoms, along with an informed approach to treatment and patient education, can help mitigate the risks associated with agranulocytosis and ensure better health outcomes for those undergoing antithyroid therapy.
Original source:
This page is merely a summary which is automatically generated hence you should visit the source to read the original article which includes the author, publication date, notes and references.
Sandeep Ankam, Manasa Bollampally, Pravallika Guttu, Dr. Ramya Bala Prabha, Sharadha Srikanth, Dr. Uma Maheswara Rao.V
World Journal of Pharmaceutical Research:
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Full text available for: Carbimazole induced agranulocytosis with hypothyriodism – a case report
Source type: An International Peer Reviewed Journal for Pharmaceutical and Medical and Scientific Research
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FAQ section (important questions/answers):
What is agranulocytosis and how does it occur?
Agranulocytosis is a severe decrease in white blood cells, often caused by medications like antithyroid drugs. It can result from direct bone marrow toxicity or an immune response, making patients susceptible to infections.
What are the common symptoms of agranulocytosis?
Symptoms of agranulocytosis include fever, sore throat, mouth ulcers, bruising, and general malaise. Patients taking antithyroid drugs should report these symptoms immediately to their healthcare provider.
Which medications are associated with agranulocytosis?
Agranulocytosis is linked to antithyroid medications such as Carbimazole, Propylthiouracil, and Methimazole. These drugs pose a significant risk of hematological dysfunctions.
Who is at increased risk for drug-induced agranulocytosis?
Women and individuals over 65 years old are at an increased risk for developing agranulocytosis as a result of antithyroid drug therapy.
What should be done if agranulocytosis occurs?
If agranulocytosis occurs, immediate discontinuation of the antithyroid drug is necessary. Patients should be closely monitored for complications and may require hospitalization for further treatment.
How prevalent is agranulocytosis in patients on antithyroid drugs?
Agranulocytosis occurs in about 0.17% to 0.6% of patients taking antithyroid drugs, with a notable mortality rate. It is considered a serious medical emergency.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Carbimazole induced agranulocytosis with hypothyriodism – a case report”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Drug:
In the context of this case report, 'Drug' refers to medications that are used to treat hyperthyroidism, specifically antithyroid drugs like Carbimazole. These drugs are essential for managing the disease but carry risks of severe side effects, one of the most serious being drug-induced agranulocytosis, which necessitates careful monitoring and immediate medical attention if symptoms arise.
2) Blood:
The term 'Blood' in this case study pertains to the evaluation of various blood parameters to diagnose the patient's condition. Complete blood counts (CBC) revealed significant findings such as low hemoglobin and leukocyte counts, indicating agranulocytosis, which is critical for understanding the hematological impact of Carbimazole therapy.
3) Fever:
In this report, 'Fever' is a key symptom that may indicate a serious condition like agranulocytosis. Patients on antithyroid medications are advised to monitor for fever as it may signal an infection that could be exacerbated by the drug-induced decrease in white blood cell count, urging prompt medical intervention.
4) Toxicity:
The word 'Toxicity' refers to the harmful effects of drugs, particularly the adverse events caused by Carbimazole which can lead to agranulocytosis and potentially life-threatening conditions. Understanding toxicity helps healthcare providers assess risks versus benefits in managing hyperthyroidism with antithyroid agents.
5) India:
In this case report, 'India' denotes the geographical context where this medical scenario occurs, specifically in Hyderabad, Telangana state. This contextual background enriches the understanding of healthcare practices and drug usage patterns in Indian patients with hyperthyroidism undergoing treatment with Carbimazole.
6) Chang:
The reference to 'Chang' is related to a cited study or report authored by Chang Gung Medical Journal, which provided evidence of antithyroid drug-induced agranulocytosis. Scholarly citations like this lend credibility to the case report by grounding it in the existing body of literature regarding similar medical cases.
7) Ulcer:
The term 'Ulcer' is mentioned in relation to symptoms that patients should watch for while on antithyroid drugs. Oral ulcers can represent a serious side effect of drug-induced agranulocytosis, highlighting the need for increased awareness and rapid communication with healthcare providers if such symptoms occur.
8) Life:
In this case report, 'Life' is associated with the severity of agranulocytosis, which can lead to life-threatening infections. Understanding the life-threatening potential of agranulocytosis prompts the need for immediate medical attention, underlining the critical nature of symptom awareness among patients prescribed antithyroid medication.
9) Discussion:
The 'Discussion' section of the report elaborates on the implications of the case findings and broader clinical considerations. It contextualizes the significance of agranulocytosis as a rare but severe reaction to antithyroid drugs, reinforcing the need for caution and monitoring during treatment for hyperthyroidism.
10) Medicine:
The term 'Medicine' encapsulates the field of healthcare concerned with diagnosing, treating, and preventing diseases, such as hyperthyroidism. This case report contributes to medical knowledge by detailing adverse drug reactions and management strategies, serving as an educational resource for healthcare professionals in the field.
11) Prabha (Prabhā):
In the document, 'Prabha' refers to Dr. Ramya Bala Prabha, one of the authors involved in the case report. Her contributions may signify a collaborative effort in documenting the clinical challenge and insights gained from managing a complex case of Carbimazole-induced agranulocytosis.
12) Manasa (Manasā, Mānasā, Mānasa, Manasha):
The name 'Manasa' refers to one of the co-authors, Manasa Bollampally, who contributed to the research and documentation of this case study. The involvement of multiple authors suggests a collaborative approach to understanding drug-induced complications within the context of hyperthyroidism treatment.
13) Ramya (Ramyā):
The term 'Ramya' pertains to Dr. Ramya Bala Prabha, one of the researchers involved in the case report. Her name exemplifies the academic contributions to understanding the clinical effects of anti-thyroid medications, specifically relating to their potential for serious side effects like agranulocytosis.
14) Sugar:
The term 'Sugar' is relevant in the context of the patient's blood sugar level, indicated as 149 mg/dl, which relates to her type-2 diabetes condition. Monitoring blood sugar is crucial in patients with concurrent hyperthyroidism and diabetes, ensuring overall metabolic control during treatment.
15) Pulse:
The term 'Pulse' is significant as it provides vital signs reflecting the patient's cardiovascular status. In the case report, the pulse rate was noted, indicating the clinical assessment of heart function, which is essential for comprehensive evaluation in hypertensive patients with hyperthyroidism.
16) Study (Studying):
The word 'Study' refers to the broader collection of research and case reports related to the incidence and understanding of agranulocytosis induced by antithyroid medications. This case report contributes to ongoing studies by providing detailed observations, enhancing clinical knowledge about potential drug-related complications.
17) Bala (Bāla, Balā, Bālā):
In the text, 'Bala' is part of the name Dr. Ramya Bala Prabha, a contributing author to this case report. The inclusion of her name emphasizes the collaborative nature of medical research, as well as the importance of interdisciplinary approaches in managing complex patient cases related to drug therapy.
18) Male (Mālē):
The term 'Male' highlights the demographic information related to the prevalence rates of hyperthyroidism and its treatment, emphasizing that the condition is more common among females. Understanding gender differences in disease prevalence is critical for tailoring treatment approaches and raising awareness about risks associated with antithyroid drug therapy.