Graves' disease associated with autoimmune hemolytic anemia in a patient who developed a methimazole-induced agranulocytosis and acute thyrotoxic heart disease rapidly prepared for total thyroidectomy
Publication Date
2019
Document Type
Research
Abstract
Autoimmune hemolytic anemia is among the autoimmune disorders associated with Graves' disease and is the rarest form of anemia associated with it. We present a case of a 39-year old Filipino female diagnosed with Graves' disease for 2 months, who was maintained on Methimazole 40 mg/day, and admitted for 1-day history of fever and odynophagia. Methimazole was withheld and she was diagnosed with methimazole-induced agranulocytosis. She was given broad spectrum antibiotics, high dose propranolol, granulocyte colony stimulating factor and lithium carbonate. She presented with autoimmune hemolytic anemia (hemoglobin at 86 g/L) and hydrocortisone was added to her regimen. She was then advised to undergo radioactive iodine therapy once her agranulocytosis resolved. Seven days into her admission, she suddenly developed ventricular fibrillation necessitating defibrillation and resuscitation and was managed accordingly. Two-dimensional (2D) echocardiogram with color doppler showed an ejection fraction (EF) of 38% with multiple segmental wall motion abnormality. She was then rapidly prepared for total thyroidectomy using saturated solution of potassium iodide (SSKI). She underwent total thyroidectomy after normalization of FT4 and was discharged few days after. One month post-discharge, repeat 2D echocardiogram showed an improved EF of 59% and normalization of ventricular wall motion, hemoglobin was normal, and direct and indirect Coomb's tests were negative. Patient is doing well on levothyroxine. These complicating events presenting together in a patient with Graves' disease are unusual. Reporting these cases and the outcomes of management are necessary to contribute to the growing knowledge and database of these disease complications.
APA Citation
Delica, Vasha Gianna S. and Pagsisihan, Daveric A., "Graves' disease associated with autoimmune hemolytic anemia in a patient who developed a methimazole-induced agranulocytosis and acute thyrotoxic heart disease rapidly prepared for total thyroidectomy" (2019). Resident Research. 88.
https://greenprints.dlshsi.edu.ph/resident-research/88