STUDENT ----- Unique Identifier 93321755 Authors Tajiri J. Noguchi S. Morita M. Tamaru M. Murakami N. Institution Noguchi Thyroid Clinic and Hospital Foundation. Title Studies on onset patterns in antithyroid drug-induced agranulocytosis. Japanese Source Nippon Naibunpi Gakkai Zasshi - Folia Endocrinologica Japonica. 695:530-3, 1993 May 20. Abstract We studied the patterns of the onset of antithyroid drug-induced agranulocytosis. From 1975 to 1990, 19,050 patients with Graves disease receiving treatment with antithyroid drugs were seen at our clinic. For all patients with Graves disease treated with an antithyroid drug, a routine white blood cell count was done every 2 weeks until euthyroid state was gained, and a count was done once every moth thereafter. Of these, 70 were found to have agranulocytosis. Agranulocytosis was defined as a granulocyte count of 500/mm3 or less. In only 19 of the 70 was agranulocytosis detected after the occurrence of infection symptomatic: classical agranulocytosis. The remaining 51 patients were asymptomatic when agranulocytosis was detected during routine white blood cell and granulocyte count monitoring. However, 17 of the 51 patients became symptomatic several days after the withdrawal of antithyroid drug treatment shifted from asymptomatic to symptomatic agranulocytosis. Thirty-four patients had no symptoms of infection throughout the course of the disease asymptomatic agranulocytosis. In conclusion, 1 We found three patterns in the onset of antithyroid drug-induced agranulocytosis: classical symptomatic, a shift from asymptomatic to symptomatic, and asymptomatic agranulocytosis, 2 Unexpectedly, classical symptomatic agranulocytosis was seen in only 19 of the 70 patients, 3 We were again remained of the importance of routine white blood cell and granulocyte count monitoring. Unique Identifier 92090389 Authors Tajiri J. Noguchi S. Morita M. Tamaru M. Murakami N. Institution Noguchi Thyroid Clinic and Hospital Foundation, Oita, Japan. Title Antithyroid drug therapy for Graves hyperthyroidism: is long-term administration of a small maintenance dose necessary?. Source Endocrinologia Japonica. 382:223-7, 1991 Apr. Abstract This retrospective study serves as an inquiry into the common practice of long-term administration of small maintenance doses of either methyl-mercaptoimidazole MMI or propylthiouracil PTU to Graves hyperthyroid patients who became euthyroid with primary large doses of the same drugs. One hundred and two patients with Graves hyperthyroidism treated with antithyroid drug ATD were studied. Sixty-one were treated with conventional long term therapy and 41 were treated with short-term therapy. Small maintenance doses of ATDs were not administered to the short-term therapy patients. The duration of long-term therapy was 28.6 /- 20.2 months from 12 to 48 months and that of short-term therapy was 8.4 /- 1.8 months from 5 to 11. Post therapy and follow-up observation continued for 19.0 /- 2.7 months 16-25 months in both long-term and short-term patients. Of the 61 long-term therapy patients, 20 were relapsed and 41 67.2% continue to remain in remission. So too, of the 41 short-term therapy patients, 14 relapsed and 27 65.9% still remain in remission. There was no statistical difference between the long-term and short-term therapy group in age, sex, duration of symptoms before diagnosis, antithyroid antibodies, radioactive iodine uptake, free thyroid hormone levels or goiter size before treatment or in TBII levels at cessation of ATD. It is concluded that short-term ATD therapy without a maintenance dose is sufficient and saves several months of the patients and clinicians time. Unique Identifier 90179359 Authors Tajiri J. Noguchi S. Murakami T. Murakami N. Institution Noguchi Thyroid Clinic and Hospital Foundation, Oita, Japan. Title Antithyroid drug-induced agranulocytosis. The usefulness of routine white blood cell count monitoring see comments. Comments Comment in: Arch Intern Med 1992 Jan;1521:204, 207, Comment in: Arch Intern Med 1993 Dec 27;15324:2797 Source Archives of Internal Medicine. 1503:621-4, 1990 Mar. Local Messages This journal is available at Abbott, United, Mercy, Unity. Abstract This study was aimed at establishing the importance of routine monitoring of white blood cell counts in patients with Graves disease receiving antithyroid drug treatment. In the 12-year period from 1975 to 1987, 15,398 patients with Graves disease receiving treatment with antithyroid drugs were seen at our clinic. Of these, 55 0.4% were found to have agranulocytosis. Agranulocytosis was defined as a granulocyte count of 0.5 x 109/L or less. In only 12 of the 55 patients was agranulocytosis detected after the occurrence of infection symptomatic; classic agranulocytosis. The remaining 43 patients were asymptomatic when agranulocytosis was detected during routine white blood cell count monitoring. However, 14 of these 43 patients became symptomatic several days after withdrawal of antithyroid drug treatment despite antimicrobial treatment asymptomatic to symptomatic. Twenty-nine patients who were treated appropriately had no symptom of infection throughout the course of the disease, despite the absence of or an extremely small number of granulocytes in circulation asymptomatic. These results suggest that a routine monitoring of the white blood cell count could be the most effective way of predicting and detecting agranulocytosis due to antithyroid drug treatment. Unique Identifier 94275052 Authors Meyer-Gessner M. Benker G. Lederbogen S. Olbricht T. Reinwein D. Institution Department of Clinical Endocrinology, University of Essen, Germany. Title Antithyroid drug-induced agranulocytosis: clinical experience with ten patients treated at one institution and review of the literature. Review 32 refs Source Journal of Endocrinological Investigation. 171:29-36, 1994 Jan. Abstract The frequency, predisposing factors and course of agranulocytosis granulocytes 250/microliter secondary to antithyroid drugs were studied in a cohort of 1256 continuously treated outpatients with hyperthyroidism during the 15 year period from 1973 to 1987. Two cases of agranulocytosis were detected; the frequency was 0.18% 95%-confidence intervals, 0.0-0.44%. This prevalence appears to be lower than reported in previous studies up to 1.8%. For other adverse drug reactions, there was a clear-cut relationship to initial thionamide dose and to the body mass index; most reactions occurred during the first weeks of treatment. In addition, eight patients referred for thionamide drug- induced agranulocytosis were studied, and the following results obtained: Methimazole dose in patients with agranulocytosis was almost twice as in other patients 63.3 /- 19.7 vs 34.3 /- 29.7 mg daily suggesting that this complication was related to dose. The interval between start of antithyroid drug treatment and first symptoms of agranulocytosis was 33 days median; range, 23-55 days; hence, prolonged treatment beyond this period would appear relatively safe. Withdrawal of the causative agent and treatment of infection led to recovery of leukocyte counts within 15 days median; range, 5-31 days. Two fatal outcomes were seen in referred patients. In one severely hyperthyroid patient with methimazole-induced agranulocytosis, recombinant human granulocyte/macrophage colony stimulating factor induced clinical and hematologic recovery within a few days of administration. In conclusion, agranulocytosis is the most severe side effect of antithyroid drugs. According to our results and a literature review, it occurs almost exclusively during the first ten weeks of treatment and is probably related to the drug dose.ABSTRACT TRUNCATED AT 250 WORDS References: 32 Unique Identifier 93273844 Authors Reinwein D. Benker G. Lazarus JH. Alexander WD. Institution University of Essen, Department of Clinical Endocrinology, Germany. Title A prospective randomized trial of antithyroid drug dose in Graves disease therapy. European Multicenter Study Group on Antithyroid Drug Treatment. Source Journal of Clinical Endocrinology & Metabolism. 766:1516-21, 1993 Jun. Local Messages This journal is available at Abbott. Abstract Some studies have suggested that increasing the daily dose of anti-thyroid drugs might improve long-term remission rates of Graves disease. Therefore, this question was addressed in a prospective multicenter trial involving 18 thyroid clinics in Europe, mostly in iodine-deficient or moderately iodine-sufficient regions. Five hundred and nine patients with Graves hyperthyroidism were enrolled in a prospective randomized trial comparing the remission rates after treatment with methimazole MMI at two fixed dosages 10 vs. 40 mg with levothyroxine supplementation. The treatment and follow-up periods lasted 12 months each. Sixty and seven-tenths percent of the recruited patients total, 309; 153 in the 10 mg, 156 in the 40 mg group were finally evaluated, and comparison of the two groups showed that they were well matched with respect to a wide range of variables, including parameters of thyroid function. With 10 mg MMI daily, 68.4% of the patients were euthyroid after 3 weeks, and 84.9% after 6 weeks, compared to 83.1% and 91.6%, respectively, with the use of 40 mg MMI daily. TSH receptor antibodies decreased similarly in the two groups, 25% of patients in the 10 mg group, and 30% i