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CC BY 4.0 · Journal of Diabetes and Endocrine Practice 2025; 08(01): 039-044
DOI: 10.1055/s-0045-1802357
Original Article

Awareness of Antithyroid Drug-Induced Agranulocytosis in Patients with Thyrotoxicosis

Nasser Abunamous 
1   Department of Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
,
Akram Takaleh
1   Department of Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
,
Mohamed Abdelsalhen
1   Department of Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
,
Mohamed Alqedra
1   Department of Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
,
Amena Abbara
1   Department of Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
,
Raya Almazrouei 
2   Division of Endocrinology, Department of Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
3   Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain. United Arab Emirates
,
Adnan Agha 
3   Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain. United Arab Emirates
› Author Affiliations
Funding None.
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Abstract

Objective Anti-thyroid drugs (ATDS)-induced agranulocytosis is a serious side effect that can be treated by early management if the patient has been educated to promptly self-identify agranulocytosis based on its presenting features. We aimed to assess the knowledge of patients taking carbimazole for hyperthyroidism regarding suspected agranulocytosis.

Methods This questionnaire-based cross-sectional study with prospective follow-up analyzed adult patients with hyperthyroidism who visited an endocrine clinic, in a tertiary hospital in the UAE, between January 2023 and March 2024. They were asked about their knowledge about the symptoms of agranulocytosis and the immediate steps required upon symptom observation. They were then given bilingual agranulocytosis information cards and educated either face-to-face or telephonically. Their knowledge and awareness were re-evaluated 3-6 months later. Chi-squared tests were used to assess the differences before and after patient education.

Results The initial and follow-up surveys were answered by 68 patients (mean age: 43.7 ± 17.1 years). The cohort included 48 (70.6%) females and 58 (85.3%) Emiratis. Hypothyroidism was due to Graves' disease in 64 (94.1%) patients and toxic multinodular goiter in 4 (5.9%) patients. There were 41 (60.3%) participants who responded that they had received adequate information on ATD-related agranulocytosis upon treatment initiation, which improved to 67 (98.5%) following patient education. Similarly, their self-reported confidence in identifying ATD-related side effects significantly improved (50% [34/68] vs. 100% [68/68]; p < 0.00001) after receiving education.

Conclusion Patient education and information cards on ATD-induced agranulocytosis improve patient awareness regarding symptom identification and the next steps required for suspected agranulocytosis.

Keywords

antithyroid drugs - drug-induced agranulocytosis - carbimazole - hyperthyroidism - thyrotoxicosis

Ethical Approval

The study was approved by the Tawam Human Research Ethics Committee (Ref MF2058-2023-999).


Patient Consent

Written informed consent was obtained from all participants. Data were analyzed anonymously.


Authors' Contributions

A.A. proposed and designed the study. All authors contributed to the research in conceptualization, conduct, data analysis and drafting and revision of the manuscript to fulfill the ICMJE authorship criteria. All authors reviewed and approved the final version of the manuscript and accept responsibility for its contents.




Publication History

Article published online:
03 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Davies TF, Laurberg P, Bahn RS. Hyperthyroid disorders. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. eds. Williams Textbook of Endocrinology. Philadelphia, PA: Elsevier; 2016: 369-415
    Search in Google Scholar
  • 2 Patel NN, Abraham P, Buscombe J. et al. The cost effectiveness of treatment modalities for thyrotoxicosis in a U.K. center. Thyroid 2006; 16 (06) 593-598
    CrossrefPubMedSearch in Google Scholar
  • 3 Mahant S, Shobhane U, Mahant PD. Carbimazole induced agranulocytosis with life-threatening complications, tremendous response with granulocyte-colony stimulating factor. Med J DY Patil Univ 2016; 9: 79-81
    CrossrefSearch in Google Scholar
  • 4 Meyer-Gessner M, Benker G, Lederbogen S. et al. Antithyroid drug-induced agranulocytosis: clinical experience with ten patients treated at one institution and review of the literature. J Endocrinol Invest 1994; 17 (01) 29-36
    CrossrefPubMedSearch in Google Scholar
  • 5 Nakamura H, Miyauchi A, Miyawaki N. et al. Analysis of 754 cases of antithyroid drug-induced agranulocytosis over 30 years in Japan. J Clin Endocrinol Metab 2013; 98 (12) 4776-4783
    CrossrefPubMedSearch in Google Scholar
  • 6 Pearce SHS. Spontaneous reporting of adverse reactions to carbimazole and propylthiouracil in the UK. Clin Endocrinol (Oxf) 2004; 61 (05) 589-594
    CrossrefPubMedSearch in Google Scholar
  • 7 Robinson J, Richardson M, Hickey J. et al. Patient knowledge of antithyroid drug-induced agranulocytosis. Eur Thyroid J 2014; 3 (04) 245-251
    CrossrefPubMedSearch in Google Scholar
  • 8 Beshyah SA, Bashier AE, Afandi B. et al. Physicians' and patients' perceptions and practices concerning antithyroid drug-induced agranulocytosis. JDEP 2022; 5: 145-153
    Search in Google Scholar
  • 9 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research. Geneva: World Health Organization; 1993
    Search in Google Scholar
  • 10 Chong LPL, James LJ. Improving patient awareness of antithyroid medications. Endocr Abstracts 2010; 21: 71
    Search in Google Scholar
  • 11 National Institute for Health Care Excellence (NICE). Neutropenic sepsis. Accessed January 14, 2025 at: http://pathways.nice.org.uk/pathways/neutropenic-sepsis
  • 12 Huang CH, Li KL, Wu JH. et al. Antithyroid drug-induced agranulocytosis: report of 13 cases. Chang Gung Med J 2007; 30 (03) 242-248
    PubMedSearch in Google Scholar
  • 13 Tajiri J, Noguchi S. Antithyroid drug-induced agranulocytosis: special reference to normal white blood cell count agranulocytosis. Thyroid 2004; 14 (06) 459-462
    CrossrefPubMedSearch in Google Scholar