Propylthiouracil-induced agranulocytosis complicated by severe infection in a patient with Graves' disease: A case report.

Abstract

Objective. Graves' disease is an autoimmune disease of the thyroid gland causing hyperthyroidism due to thyroid-stimulating hormone receptor autoantibodies. A rare, but serious complication of anti-thyroid drug therapy is agranulocytosis, a critical reduction in granulocytes leading to neutropenia and impaired infection defense. Case report. We report a case of a 32-year-old woman with Graves' disease who developed propylthiouracil-induced agranulocytosis and pancytopenia with concurrent severe infection. The patient was treated with antibiotics and granulocyte colony-stimulating factor ultimately undergoing total thyroidectomy. Conclusion. The case highlights a rare, but potentially life-threatening complication of antithyroid drug therapy. We emphasize the importance of close monitoring of patients treated with anti-thyroid drugs. Early recognition and prompt intervention are crucial as agranulocytosis is not always symptomatic. Additionally, early thyroidectomy should be considered in women of childbearing age as recurrent disease flares and therapeutic switching not only increase the risk of agranulocytosis and infection, but may also delay pregnancy.