Rapid Preoperative Preparation for Thyroidectomy of a Severely Hyperthyroid Patient with Graves’ Disease who Developed Agranulocytosis

Authors

  • Daveric Pagsisihan Department of Internal Medicine, De La Salle University Medical Center
  • Aimee Andag-Silva Department of Internal Medicine, De La Salle University Medical Center
  • Olivia Piores-Roderos Department of Internal Medicine, De La Salle University Medical Center
  • Ma. Ailsa Escobin Department of Internal Medicine, De La Salle University Medical Center

Abstract

Preoperative preparation of the hyperthyroid patient for thyroidectomy is imperative to avoid perioperative complications due to severe thyrotoxicosis. The mainstay of preparation is the administration of anti-thyroid drugs (ATD). When ATDs cause adverse reactions, an alternative regimen to prepare the patient for definitive management is crucial. We present the case of a 35-year-old Filipino female with Graves’ disease who developed methimazole-induced agranulocytosis. She refused to undergo radioactive iodine (RAI) therapy. She was admitted for thyroidectomy with elevated thyroid hormone levels. She was rapidly prepared for thyroidectomy using high-dose steroid, beta-adrenergic blocker, propylthiouracil (PTU) and Lugol’s solution. The patient’s free thyroxine level decreased after 8 days of treatment, without complications. She then underwent an uneventful subtotal thyroidectomy. In conditions with very limited options, although contraindicated, administration of another ATD may be the last alternative for patients who developed agranulocytosis.  

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References

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Published

2015-07-31

How to Cite

Pagsisihan, D., Andag-Silva, A., Piores-Roderos, O., & Escobin, M. A. (2015). Rapid Preoperative Preparation for Thyroidectomy of a Severely Hyperthyroid Patient with Graves’ Disease who Developed Agranulocytosis. Journal of the ASEAN Federation of Endocrine Societies, 30(1), 48. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/200

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Section

Case Reports