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2000
Volume 20, Issue 3
  • ISSN: 1574-8863
  • E-ISSN: 2212-3911

Abstract

Introduction

Methimazole is an antithyroid drug known to cause hematological toxicity, including agranulocytosis and, very rarely, pancytopenia. We herein present a case of a patient with Graves' Disease (GD) who developed methimazole-induced pancytopenia.

Case Report

A 53-year-old Peruvian woman with GD, initially treated with methimazole 20 mg BID, experienced odynophagia, fever, and malaise after 37 days of treatment. The initial diagnosis was agranulocytosis, leading to the discontinuation of methimazole and initiation of antibiotics. Due to persistent neutropenia, a Granulocyte Colony-stimulating Factor (G-CSF) was administered. Eight days later, she developed pancytopenia and was managed with hematopoietic agents and platelet transfusions. The patient recovered with normalization of the blood count, eliminating the need for Bone Marrow (BM) examination. Radioiodine therapy was chosen as the definitive treatment, resulting in hypothyroidism. Currently, the patient is thyroidal and hematologically stable.

Conclusion

Methimazole-induced pancytopenia is a rare and serious complication; however, with appropriate treatment, complete recovery can be achieved.

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2024-08-02
2025-10-25

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References

  1. WatanabeN. NarimatsuH. NohJ.Y. Antithyroid drug-induced hematopoietic damage: A retrospective cohort study of agranulocytosis and pancytopenia involving 50,385 patients with graves’ disease.J. Clin. Endocrinol. Metab.2012971E49E5310.1210/jc.2011‑2221 22049174
     [Google Scholar]
  2. ChengY. XiaX.Y. ZhangW. Clinical characteristics of antithyroid drug-induced aplastic anemia cases over the past 30 years.Front. Endocrinol.202314106472310.3389/fendo.2023.1064723 36777352
     [Google Scholar]
  3. WijayaN. Ong-RamosC. Methimazole-induced aplastic anemia with concomitant hepatitis in a young Filipina with graves’ disease.J. ASEAN Fed. Endocr. Soc.20193419910210.15605/jafes.034.01.16 33442144
     [Google Scholar]
  4. HondaM. Successful treatment of methimazole-induced severe aplastic anemia by granulocyte colony-stimulating factor, methylprednisolone, and cyclosporin.ISRN Endocrinol.201120111410.5402/2011/732623 22363886
     [Google Scholar]
  5. MezquitaP. LunaV. Muñoz-TorresM. Methimazole-induced aplastic anemia in third exposure: Successful treatment with recombinant human granulocyte colony-stimulating factor.Thyroid19988979179410.1089/thy.1998.8.791 9777751
     [Google Scholar]
  6. BreierD.V. RendoP. GonzalezJ. ShiltonG. StivelM. GoldzteinS. Massive plasmocytosis due to methimazole‐induced bone marrow toxicity.Am. J. Hematol.200167425926110.1002/ajh.1127 11443640
     [Google Scholar]
  7. RodriguezV. GonzalesK.M. IqbalA.M. Pancytopenia secondary to autoimmune vitamin B12 deficiency in graves’ disease.AACE Clin. Case Rep.202066e282e28510.4158/ACCR‑2020‑0055 33244485
     [Google Scholar]
  8. GarlaV.V. Abdul SalimS. Yanes-CardozoL.L. Pancytopenia: A rare complication of graves’ disease.BMJ Case Rep.20182018bcr-2017-22388710.1136/bcr‑2017‑223887 29525760
     [Google Scholar]
  9. WatsonA. KolinskiJ. SuchiM. ElkadriA. Bone marrow suppression associated with celiac disease in a 4-year-old boy.ACG Case Rep. J.202182e0053810.14309/crj.0000000000000538 33644248
     [Google Scholar]
  10. HalfdanarsonT.R. LitzowM.R. MurrayJ.A. Hematologic manifestations of celiac disease.Blood2007109241242110.1182/blood‑2006‑07‑031104 16973955
     [Google Scholar]
  11. ScappaticcioL. BellastellaG. MaiorinoM.I. Graves’ hyperthyroidism-related pancytopenia: A case report with literature review.Hormones 20212019310010.1007/s42000‑020‑00227‑5 32638234
     [Google Scholar]
  12. HillA. HillQ.A. Autoimmune hemolytic anemia.Hematology (Am. Soc. Hematol. Educ. Program)20182018138238910.1182/asheducation‑2018.1.382 30504336
     [Google Scholar]
  13. NeharaH. GuptaB. ParmarS. KumarV. SihagD. BeniwalS. Antithyroid drug-induced pancytopenia followed by acute lymphoblastic leukemia: A rare case.Thyroid Res Pract202017314910.4103/trp.trp_45_20
     [Google Scholar]
  14. BiswasN. AhnY.H. GoldmanJ.M. SchwartzJ.M. Aplastic anemia associated with antithyroid drugs.Am. J. Med. Sci.1991301319019410.1097/00000441‑199103000‑00008 2000892
     [Google Scholar]
  15. YangJ. ZhuY.J. ZhongJ.J. Characteristics of antithyroid drug–induced agranulocytosis in patients with hyperthyroidism: A retrospective analysis of 114 cases in a single institution in China involving 9690 patients referred for radioiodine treatment over 15 years.Thyroid201626562763310.1089/thy.2015.0439 26867063
     [Google Scholar]
  16. YamamotoA. KatayamaY. TomiyamaK. Methimazole-induced aplastic anemia caused by hypocellular bone marrow with plasmacytosis.Thyroid200414323123510.1089/105072504773297911 15072706
     [Google Scholar]
  17. Escobar-MorrealeH.F. BravoP. García-RoblesR. García-LarañaJ. CalleH.D.L. SanchoJ.M. Methimazole-induced severe aplastic anemia: unsuccessful treatment with recombinant human granulocyte-monocyte colony-stimulating factor.Thyroid199771677010.1089/thy.1997.7.67 9086574
     [Google Scholar]
  18. LeeJ.H. LeeJ. SungS.H. BaeS.H. KimS.G. OhH.K. A case of Methimazole-induced pancytopenia: Successful treatment with recombinant human granulocyte colony-stimulating factor.J. Endocr. Soc.200621654855110.3803/jkes.2006.21.6.548
     [Google Scholar]
  19. LynchM.J. WoodfordN.W.F. Fatality complicating agranulocytosis in the setting of carbimazole therapy.Forensic Sci. Med. Pathol.20084424624910.1007/s12024‑008‑9038‑8 19291446
     [Google Scholar]
  20. M Suryanarayana K. A case of graves’ disease with rare complication of carbimazole induced pancytopenia.Int J Contemp Med202072B1B310.21276/ijcmr.2020.7.2.43
     [Google Scholar]
  21. PincetL. GorostidiF. Graves disease causing pancytopenia: Case report and literature review.Clin. Med. Insights Case Rep.20181110.1177/1179547618781090 30083058
     [Google Scholar]
  22. López-KarpovitchX. Ulloa-AguirreA. von EiffC. Hurtado-MonroyR. AlanisA. Treatment of methimazole-induced severe aplastic anemia with recombinant human granulocyte-monocyte colony-stimulating factor and glucocorticosteroids.Acta Haematol.199287314815010.1159/000204742 1642096
     [Google Scholar]
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Methimazole-Induced Pancytopenia in a Patient with Graves' Disease: A Case Report and Literature Review
Curr Drug Saf 20, 371 (2025); https://doi.org/10.2174/0115748863305536240726053827
/content/journals/cds/10.2174/0115748863305536240726053827
/content/journals/cds/10.2174/0115748863305536240726053827
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  • Article Type:     Case Report
Keyword(s): acquired agranulocytosis; Antithyroid agents; aplastic anemia; graves disease; methimazole; pancytopenia

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