Propylthiouracil induced C-ANCA positive agranulocytosis complicating Graves' thyrotoxicosis in pregnancy.

Abstract

BACKGROUND:

Thionamide induced agranulocytosis is associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA) in some patients. This poses a particular challenge when it occurs during pregnancy.

AIMS:

To report a case of a 31-year-old woman with Graves' disease who presented at 11 weeks gestation with propylthiouracil induced agranulocytosis.

METHODS:

After cessation of propylthiouracil the patient developed recurrent thyrotoxicosis, and underwent an elective subtotal thyroidectomy at 23 weeks gestation.

RESULTS:

The patient required postoperative thyroxine replacement therapy. Subsequent pregnancy was uneventful and she delivered a healthy baby boy at 41 weeks gestation. As part of our routine work up for agranulocytosis we measured C-ANCA levels, which were significantly elevated.

CONCLUSION:

This case highlights the association of propylthiouracil induced ANCA positivity and agranulocytosis. Second trimester subtotal thyroidectomy was safe and effective in treating this pregnant patient's thyrotoxicosis.

• Authors: F M Finucane, J O'Connell, B T Kinsley
• Journal: Irish journal of medical science (Ir J Med Sci) Vol. 177 Issue 1 Pg. 69-71 (Mar 2008) ISSN: 1863-4362 [Electronic] Ireland
• PMID: 17611791 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Antineutrophil Cytoplasmic
• Antithyroid Agents
• Propylthiouracil

Topics

• Adult
• Agranulocytosis (blood, chemically induced)
• Antibodies, Antineutrophil Cytoplasmic (blood)
• Antithyroid Agents (adverse effects)
• Female
• Graves Disease (diagnosis, drug therapy, surgery)
• Humans
• Pregnancy
• Pregnancy Complications (diagnosis, drug therapy, surgery)
• Propylthiouracil (adverse effects)
• Term Birth
• Thyroidectomy
• Thyrotoxicosis (diagnosis, drug therapy, surgery)