{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:58:37Z","timestamp":1790114317409,"version":"4.0.1"},"reference-count":23,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Agranulocytosis is a rare antithyroid drug treatment (ATD) side effect seen in children suffering from Graves\u2019 disease (GD). Neutropenia is a recognized adverse event associated with ATD but has also been reported as pre-treatment neutropenia in GD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study to analyze the longitudinal clinical and biochemical data of 161 pediatric patients with GD who received either methimazole (MMI) or carbimazole (CBZ) as ATD. The inclusion criteria were elevated free thyroxine (fT4 &gt;25 pmol\/L), suppressed thyrotropin (TSH &lt;0.05 mlU\/mL), and elevated thyrotropin receptor antibodies (TSHRAbs &gt;2.5 IU\/L). Absolute neutrophil count (ANC) was used to define neutropenia (ANC &lt;1800\/\u00b5L) and agranulocytosis (ANC &lt;500\/\u00b5L).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Nine of the 161 patients had neutropenia at diagnosis (ANC: 1348\/\u00b5L \u00b1 250) without further deterioration under ATD. In this subgroup, we found higher levels of free triiodothyronine (fT3: 31.45 pmol\/L \u00b1 3.99) at diagnosis in comparison with those who developed neutropenia (26.29 pmol\/L \u00b1 12.96;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.07) and those without neutropenia before and during therapy (23.12 pmol\/L \u00b1 13.7;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.003). Thirty-eight patients (23.6%) became neutropenic (ANC: 1479\/\u00b5L \u00b1 262) while receiving ATD. Neutropenia occurred after a mean of 551.8 (range: 10\u20131376) days, mostly without further deterioration. Two of these 38 patients developed agranulocytosis and underwent emergency thyroidectomy. The patients with neutropenia were significantly younger (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.031). Neutropenia occurred significantly more often in patients receiving CBZ (50%;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 20\/40) than in those receiving MMI (16.5%;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 18\/110;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.001). The minimum ANC was significantly lower in the CBZ (1971\/\u00b5L \u00b1 1008) than in the MMI group (2546 \u00b1 959);\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.004.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Neutropenia occurred significantly more often under CBZ than MMI. As this is potentially due to higher immunogenicity, we suggest that children with GD should be treated with MMI. Frequent measurements of ANC may be needed to detect severe agranulocytosis, although low pre-treatment ANC may not necessarily be a contraindication to ATD treatment. Young age may be potentially associated with an increased risk of reduced ANC. Further investigation is necessary to fully understand risk factors for neutropenia in children with GD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/thy.2023.0673","type":"journal-article","created":{"date-parts":[[2024,4,13]],"date-time":"2024-04-13T13:17:31Z","timestamp":1713014251000},"page":"735-743","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Neutropenia Occurs More Often Under Carbimazole than Under Methimazole Treatment in Pediatric Graves\u2019 Disease Patients"],"prefix":"10.1177","volume":"34","author":[{"given":"Vera","family":"Schempp","sequence":"first","affiliation":[{"name":"Divisions of Pediatric Endocrinology, University Children\u2019s Hospitals, Bonn, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayse Nurcan","family":"Cebeci","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Endocrinology, University Children\u2019s Hospitals, Erlangen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Reinauer","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Endocrinology, University Children\u2019s Hospitals, Duesseldorf, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Woelfle","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Endocrinology, University Children\u2019s Hospitals, Erlangen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmuth-G\u00fcnther","family":"D\u00f6rr","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Endocrinology, University Children\u2019s Hospitals, Erlangen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Th\u00e9r\u00e8se","family":"Roosen","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Endocrinology, University Children\u2019s Hospitals, Bonn, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Gohlke","sequence":"additional","affiliation":[{"name":"D-MATH, ETH Zurich, Zurich, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Gohlke","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Endocrinology, University Children\u2019s Hospitals, Bonn, 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