- Clinical Study
- Characteristics of Korean Patients with Antithyroid Drug-Induced Agranulocytosis: A Multicenter Study in Korea
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Hee Kyung Kim, Jee Hee Yoon, Min Ji Jeon, Tae Yong Kim, Young Kee Shong, Min Jin Lee, Bo Hyun Kim, In Joo Kim, Ji Young Joung, Sun Wook Kim, Jae Hoon Chung, Ho-Cheol Kang
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Endocrinol Metab. 2015;30(4):475-480. Published online December 31, 2015
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DOI: https://doi.org/10.3803/EnM.2015.30.4.475
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Abstract
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- Background
Antithyroid drugs (ATDs) can lead to the development of agranulocytosis, which is the most serious adverse effect. Characteristics of ATD-induced agranulocytosis (AIA) have seldom been reported due to the rarity. In this study, we characterized the clinical features for AIA in Korean patients. MethodsWe retrospectively reviewed data from patients with AIA diagnosed between 1997 and 2014 at four tertiary hospitals. Agranulocytosis was defined as an absolute neutrophil count (ANC) below 500/mm3. ResultsThe mean age of the patients (11 males, 43 females) was 38.2±14.9 years. Forty-eight patients (88.9%) with AIA had fever and sore throat on initial presentation, 20.4% of patients developed AIA during the second course of treatment, and 75.9% of patients suffered AIA within 3 months after initiation of ATD. The patients taking methimazole (n=39) showed lower levels of ANC and more frequent use of granulocyte-macrophage colony-stimulating factor than propylthiouracil (n=15) users. The median duration of agranulocytosis was 5.5 days (range, 1 to 20). No differences were observed between the long (≥6 days) and short recovery time (≤5 days) groups in terms of age, gender, ATDs, duration of ATDs, or initial ANC levels. Four patients (7.4%) who were taking ATDs for less than 2 months died of sepsis on the first or second day of hospitalization. ConclusionThe majority of AIA incidents occur in the early treatment period. Considering the high fatality rate of AIA, an early aggressive therapeutic approach is critical and patients should be well informed regarding the warning symptoms of the disease.
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Citations
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- Novel Association of KLRC4-KLRK1 Gene Polymorphisms with
Susceptibility and Progression of Antithyroid Drug-Induced
Agranulocytosis
Yayi He, Pan Ma, Yuanlin Luo, Xiaojuan Gong, Jiayang Gao, Yuxin Sun, Pu Chen, Suliang Zhang, Yuxin Tian, Bingyin Shi, Bao Zhang Experimental and Clinical Endocrinology & Diabetes.2024; 132(01): 17. CrossRef - A Disproportionality Analysis of the Adverse Effect Profiles of Methimazole and Propylthiouracil in Patients with Hyperthyroidism Using the Japanese Adverse Drug Event Report Database
Masanori Arai, Takahiro Tsuno, Hiromi Konishi, Kuniyuki Nishiyama, Yasuo Terauchi, Ryota Inoue, Jun Shirakawa Thyroid®.2023; 33(7): 804. CrossRef - The Current Status of Hyperthyroidism in Korea
Hyemi Kwon Endocrinology and Metabolism.2023; 38(4): 392. CrossRef - Clinical characteristics of neutropenic patients under anti-thyroid drug: Twelve year experience in a medical center
Chih-Hsueh Tseng, Chi-Lung Tseng, Harn-Shen Chen, Pei-Lung Chen, Chun-Jui Huang Journal of the Chinese Medical Association.2023;[Epub] CrossRef - Association of MICA gene polymorphisms with thionamide-induced agranulocytosis
P. Ma, P. Chen, J. Gao, H. Guo, S. Li, J. Yang, J. Lai, X. Yang, B. Zhang, Y. He Journal of Endocrinological Investigation.2021; 44(2): 363. CrossRef - Efficacy and adverse events related to the initial dose of methimazole in children and adolescents with Graves’ disease
Hyun Gyung Lee, Eun Mi Yang, Chan Jong Kim Annals of Pediatric Endocrinology & Metabolism.2021; 26(3): 199. CrossRef - MICA polymorphisms associated with antithyroid drug‐induced agranulocytosis in the Chinese Han population
Xiaojuan Gong, Pu Chen, Pan Ma, Jiayang Gao, Jingsi Yang, Hui Guo, Chunxia Yan, Bao Zhang, Yayi He Immunity, Inflammation and Disease.2020; 8(4): 695. CrossRef - The Management of Thyroid Disease in COVID-19 Pandemic
Won Sang Yoo, Hyun-Kyung Chung International Journal of Thyroidology.2020; 13(2): 65. CrossRef - Increased Risk of Antithyroid Drug Agranulocytosis Associated with Amiodarone-Induced Thyrotoxicosis: A Population-Based Cohort Study
Michal Gershinsky, Walid Saliba, Idit Lavi, Chen Shapira, Naomi Gronich Thyroid.2019; 29(2): 193. CrossRef - A Case of Acute Supraglottitis Following Anti-Thyroid Drug-Induced Agranulocytosis
Jung Jun Lee, Dong Young Kim, Jeon Yeob Jang Journal of The Korean Society of Laryngology, Phoniatrics and Logopedics.2019; 30(2): 128. CrossRef - Association of HLA-B∗38:02 with Antithyroid Drug-Induced Agranulocytosis in Kinh Vietnamese Patients
Mai Phuong Thao, Pham Vo Anh Tuan, Le Gia Hoang Linh, Lam Van Hoang, Phan Huu Hen, Le Tuyet Hoa, Hoang Anh Vu, Do Duc Minh International Journal of Endocrinology.2018; 2018: 1. CrossRef - Severe Gingival Ulceration and Necrosis Caused by an Antithyroid Drug: One Case Report and Proposed Clinical Approach
Ying‐Ying Chang, Chih‐Wen Tseng, Kuo Yuan Clinical Advances in Periodontics.2018; 8(1): 11. CrossRef - Emphasis on the early diagnosis of antithyroid drug-induced agranulocytosis: retrospective analysis over 16 years at one Chinese center
Y. He, J. Li, J. Zheng, Z. Khan, W. Qiang, F. Gao, Y. Zhao, B. Shi Journal of Endocrinological Investigation.2017; 40(7): 733. CrossRef - Association of HLA-B and HLA-DRB1 polymorphisms with antithyroid drug-induced agranulocytosis in a Han population from northern China
Yayi He, Jie Zheng, Qian Zhang, Peng Hou, Feng Zhu, Jian Yang, Wenhao Li, Pu Chen, Shu Liu, Bao Zhang, Bingyin Shi Scientific Reports.2017;[Epub] CrossRef - Use of granulocyte colony‐stimulating factor in the treatment of methimazole‐induced agranulocytosis: a case report
Asha Birmingham, Carissa Mancuso, Craig Williams Clinical Case Reports.2017; 5(10): 1701. CrossRef - 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis
Douglas S. Ross, Henry B. Burch, David S. Cooper, M. Carol Greenlee, Peter Laurberg, Ana Luiza Maia, Scott A. Rivkees, Mary Samuels, Julie Ann Sosa, Marius N. Stan, Martin A. Walter Thyroid.2016; 26(10): 1343. CrossRef
- Thyroid
- Weight Changes in Patients with Differentiated Thyroid Carcinoma during Postoperative Long-Term Follow-up under Thyroid Stimulating Hormone Suppression
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Seo Young Sohn, Ji Young Joung, Yoon Young Cho, Sun Mi Park, Sang Man Jin, Jae Hoon Chung, Sun Wook Kim
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Endocrinol Metab. 2015;30(3):343-351. Published online August 4, 2015
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DOI: https://doi.org/10.3803/EnM.2015.30.3.343
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4,686
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Abstract
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- Background
There are limited data about whether patients who receive initial treatment for differentiated thyroid cancer (DTC) gain or lose weight during long-term follow-up under thyroid stimulating hormone (TSH) suppression. This study was aimed to evaluate whether DTC patients under TSH suppression experience long-term weight gain after initial treatment. We also examined the impact of the radioactive iodine ablation therapy (RAIT) preparation method on changes of weight, comparing thyroid hormone withdrawal (THW) and recombinant human TSH (rhTSH). MethodsWe retrospectively reviewed 700 DTC patients who underwent a total thyroidectomy followed by either RAIT and levothyroxine (T4) replacement or T4 replacement alone. The control group included 350 age-matched patients with benign thyroid nodules followed during same period. Anthropometric data were measured at baseline, 1 to 2 years, and 3 to 4 years after thyroidectomy. Comparisons were made between weight and body mass index (BMI) at baseline and follow-up. ResultsSignificant gains in weight and BMI were observed 3 to 4 years after initial treatment for female DTC but not in male patients. These gains among female DTC patients were also significant compared to age-matched control. Women in the THW group gained a significant amount of weight and BMI compared to baseline, while there was no increase in weight or BMI in the rhTSH group. There were no changes in weight and BMI in men according to RAIT preparation methods. ConclusionFemale DTC patients showed significant gains in weight and BMI during long-term follow-up after initial treatment. These changes were seen only in patients who underwent THW for RAIT.
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Yang Jiang, Xiangju Sun, Maomin Jiang, Hewei Min, Jing Wang, Xinghua Fu, Jiale Qi, Zhenjie Yu, Xiaomei Zhu, Yibo Wu Frontiers in Public Health.2024;[Epub] CrossRef - Thyroidectomy Effects on the Body Mass Index and Thyroid-Stimulating Hormone: A Systematic Review and Meta-Analysis
Hyder Mirghani, Ahmad M Fnjan, Abdullah F Almalki, Ali F Almadan, Omar Abdullah M Alammar, Abdulaziz S Alhwiati, Amer A Laradhi, Ahmed M Bakour, Mohamad A Aljahed, Abdulmajeed M Alzahrani Cureus.2024;[Epub] CrossRef - Pre-surgery dietician counseling can prevent post-thyroidectomy body weight gain: results of an intervention trial
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Floortje Mols, Dounya Schoormans, Romana Netea-Maier, Olga Husson, Sandra Beijer, Katrijn Van Deun, Wouter Zandee, Marleen Kars, Pleun C. M. Wouters van Poppel, Suat Simsek, Patrick van Battum, Jérôme M. H. Kisters, Jan Paul de Boer, Elske Massolt, Rachel Thyroid Research.2023;[Epub] CrossRef - Effects of a low-iodine diet in post-thyroidectomy thyroid cancer patients undergoing I131 therapy at the Vietnam National Cancer Hospital
Bach Viet Hoang, Tien Thi Hong Nguyen, Yen Thi Duong, Hoa Thi Thanh Nguyen, Thu Ha Nguyen, Thanh Thi Nguyen, Lieu Thi Thu Nguyen, Huong Thi Le Nutrition and Health.2023;[Epub] CrossRef - Positive effects of thyroid replacement therapy on assisted reproductive technology outcomes in women with subclinical hypothyroidism with positive thyroid peroxidase autoantibodies
Himanshu Arora, Ineabelle Collazo, Katherine L. Palmerola, Madhumita Parmar, Manish Narasimman, Nicholas Hendon, Juergen Eisermann, Maria Bustillo F&S Reports.2022; 3(1): 32. CrossRef - Weight Gain After Thyroidectomy: A Systematic Review and Meta-Analysis
Christine N Huynh, Janina V Pearce, Le Kang, Francesco S Celi The Journal of Clinical Endocrinology & Metabolism.2021; 106(1): 282. CrossRef - Weight change in patients with differentiated thyroid carcinoma after total thyroidectomy versus lobectomy
Hae-Ryong Cho, Ra-Yeong Song, Kyung Ho Kang Korean Journal of Clinical Oncology.2020; 16(2): 127. CrossRef - Postthyroidectomy obesity in a Korean population: does the extent of surgery matter?
Min-Young Park, Sang Eun Nam, Kyoung Sik Park, Madhuri Saindane, Young-Bum Yoo, Jung-Hyun Yang, Ah-Leum Ahn, Jae-Kyung Choi, Won Seo Park Annals of Surgical Treatment and Research.2019; 97(3): 119. CrossRef - Body weight change is unpredictable after total thyroidectomy
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Min-Hee Kim, Jin-young Huh, Dong-jun Lim, Moo-Il Kang Thyroid.2017; 27(7): 936. CrossRef - Thyroid hormone and its metabolites in relation to quality of life in patients treated for differentiated thyroid cancer
E.T. Massolt, M. van der Windt, T.I.M. Korevaar, B.L.R. Kam, J.W. Burger, G.J.H. Franssen, I. Lehmphul, J. Köhrle, W.E. Visser, R.P. Peeters Clinical Endocrinology.2016; 85(5): 781. CrossRef - High Serum Levels of Thyroid-Stimulating Hormone and Sustained Weight Gain in Patients with Thyroid Cancer Undergoing Radioiodine Therapy
Hyo Jung Seo, June-Key Chung, Keon Wook Kang, E. Edmund Kim, Gi Jeong Cheon, Jin Chul Paeng, Dong Soo Lee, Young Joo Park, Do Joon Park, Jae Gol Choe International Journal of Thyroidology.2016; 9(1): 19. CrossRef
- Adrenal gland
- Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis
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Sun Mi Park, Ji Cheol Bae, Ji Young Joung, Yoon Young Cho, Tae Hun Kim, Sang-Man Jin, Sunghwan Suh, Kyu Yeon Hur, Kwang-Won Kim
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Endocrinol Metab. 2014;29(4):470-478. Published online December 29, 2014
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DOI: https://doi.org/10.3803/EnM.2014.29.4.470
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- Background
Primary hypophysitis causes varying degrees of endocrine dysfunction and mass effect. The natural course and best treatment have not been well established. MethodsMedical records of 22 patients who had been diagnosed with primary hypophysitis between January 2001 and March 2013 were retrospectively reviewed. Based on the anatomical location, we classified the cases as adenohypophysitis (AH), infundibuloneurohypophysitis (INH), and panhypophysitis (PH). Clinical presentation, endocrine function, pathologic findings, magnetic resonance imaging findings, and treatment courses were reviewed. ResultsAmong 22 patients with primary hypophysitis, 81.8% (18/22) had involvement of the posterior pituitary lobe. Two patients of the AH (2/3, 66.6%) and three patients of the PH (3/10, 30%) groups initially underwent surgical mass reduction. Five patients, including three of the PH (3/10, 33.3%) group and one from each of the AH (1/3, 33.3%) and INH (1/9, 11.1%) groups, initially received high-dose glucocorticoid treatment. Nearly all of the patients treated with surgery or high-dose steroid treatment (9/11, 82%) required continuous hormone replacement during the follow-up period. Twelve patients received no treatment for mass reduction due to the absence of acute symptoms and signs related to a compressive mass effect. Most of them (11/12, 92%) did not show disease progression, and three patients recovered partially from hormone deficiency. ConclusionDeficits of the posterior pituitary were the most common features in our cases of primary hypophysitis. Pituitary endocrine defects responded less favorably to glucocorticoid treatment and surgery. In the absence of symptoms related to mass effect and with the mild defect of endocrine function, it may not require treatment to reduce mass except hormone replacement.
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- Thyroid
- Steroid Responsive Xanthomatous Hypophysitis Associated with Autoimmune Thyroiditis: A Case Report
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Ji Young Joung, Hyemin Jeong, Yoon Young Cho, Kyoungmin Huh, Yeon-Lim Suh, Kwang-Won Kim, Ji Cheol Bae
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Endocrinol Metab. 2013;28(1):65-69. Published online March 25, 2013
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DOI: https://doi.org/10.3803/EnM.2013.28.1.65
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We report the case of a 36-year-old woman who presented with headache, fever, and amenorrhea. Laboratory analysis revealed hypopituitarism and autoimmune thyroiditis, while a cerebrospinal fluid study suggested concurrent aseptic meningitis. A magnetic resonance image (MRI) scan revealed a 1.0×0.9 cm cystic mass enlarging the sella turcica. Surgical resection via an endoscopic transsphenoidal route was performed. The histological finding of the excised tissue revealed foamy histiocytes with vacuolated cytoplasm, supporting the diagnosis of xanthomatous hypophysitis. Although a residual soft lesion was observed on the MRI image postoperatively, the patient's headache and fever improved. Ten months after surgery, the patient complained of visual impairment and headache, and the residual mass had enlarged into the suprasellar area. High dose (500 mg intravenous) methylprednisolone was administered for 3 days. During the methylprednisolone pulse therapy, the patient's visual acuity and headache improved. A follow-up MRI taken after methylprednisolone therapy showed a marked mass reduction. Our case supports an autoimmune pathophysiology for xanthomatous hypophysitis and suggests that high dose glucocorticoid therapy as a treatment option.
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