Antithyroid Drug-Induced Agranulocytosis: How Has Granulocyte Colony-Stimulating Factor Changed Therapy?
Abstract
This study examined whether granulocyte colony-stimulating factor (G-CSF) is beneficial for the treatment of antithyroid drug-induced agranulocytosis. From January 1975 to December 2001, 30,798 patients with Graves' disease were treated with antithyroid drugs at Noguchi Thyroid Clinic & Hospital Foundation. During this period, 109 patients (0.35%) were found to have agranulocytosis caused by antithyroid drugs. In the symptomatic group, the recovery time from agranulocytosis was significantly shorter after the introduction of G-CSF (5.5 +/- 3.5 days, n = 19) compared to the symptomatic group before its introduction (9.2 +/- 4.4 days, n = 37, p < 0.01). In the asymptomatic group, the recovery time from agranulocytosis was significantly shorter after the introduction of G-CSF (2.3 +/- 1.9 days, n = 15) compared to the asymptomatic group before the introduction of GCSF (5.4 +/- 4.3 days, n = 34, p < 0.05). However, G-CSF therapy was ineffective in severe cases with granulocyte count below 0.1 x 10(9)/L and symptoms. We recommend that G-CSF therapy should be applied only in asymptomatic patients and symptomatic patients with granulocyte count above 0.1 x 10(9)/L, and not for symptomatic patients with granulocyte count below 0.1 x 10(9)/L. In conclusion, G-CSF therapy shortens the period of recovery from antithyroid drug-induced agranulocytosis and benefits patients, except those with symptoms and a granulocyte count below 0.1 x 10(9)/L.
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In adults, agranulocytosis is dose dependent with MMI and rarely occurs at low doses (e.g., 5-10 mg/d).
“In adults, agranulocytosis is dose dependent with MMI and rarely occurs at low doses (e.g., 5-10 mg/d) (128,324,335).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [335]
When agranulocytosis develops, 95% of the time it occurs in the first 100 days of therapy.
“When agranulocytosis develops, 95% of the time it occurs in the first 100 days of therapy (128,324,335).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [335]
Agranulocytosis has been reported in about 0.3% of adult patients taking MMI or PTU.
“Agranulocytosis has been reported in about 0.3% of adult patients taking MMI or PTU (128,324,335).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [335]
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- Authors
- Tajiri, J., & Noguchi, S.
- Affiliations
- Tajiri Thyroid Clinic, Kumamoto, Japan.
- Noguchi Thyroid Clinic and Hospital Foundation (JP)
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2005-03
- Volume
- 15
- Issue
- 3
- Pages
- 292-297
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2068693106
- Cited by
- 68
- References
- 10
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 1 · 2017: 8 · 2016: 7 · 2015: 5 · 2014: 2 · 2013: 4 · 2012: 3
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Blood disorders and treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Keywords
- granulocyte colony-stimulating factor, Graves' disease, antithyroid drugs, neutropenia, recovery time, granulocyte count, treatment efficacy
- MeSH terms
- Agranulocytosis, Female, Graves Disease, Humans, Male, Retrospective Studies, Antithyroid Agents, Granulocyte Colony-Stimulating Factor
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