{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T13:46:54Z","timestamp":1794491214374,"version":"4.9.1"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T00:00:00Z","timestamp":1598918400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objective<\/jats:title><jats:p>Neutropenia, a low absolute neutrophil count (ANC), may be a sign of new\u2010onset hyperthyroidism. The aim of this systematic review and meta\u2010analysis was to provide the most reliable estimates of prevalence, degree and response to treatments of neutropenia in the pure hyperthyroidism setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive literature search was performed in PubMed and Scopus databases for retrieving articles in English and non\u2010English languages reporting ANC values\/neutropenic cases at presentation and after therapy in patients with hyperthyroidism. A proportion meta\u2010analysis was performed with DerSimonian and Laird method (random\u2010effects model). Pooled data were presented with 95% confidence intervals (95% CI) and displayed in a forest plot. <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> statistic index was used to quantify the heterogeneity among the studies. Sensitivity analyses for the prevalence of neutropenia and the mean of ANC in hyperthyroid patients were performed by excluding the studies without full details. Trim and fill analysis and Egger's linear regression test were carried out to evaluate the publication bias. A two\u2010sided <jats:italic>P<\/jats:italic>\u2010value of &lt;.05 was regarded as significant for all analyses. The National Heart, Lung and Blood Institute Quality Assessment Tool was used to evaluate the quality of studies included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The literature search yielded 1880 studies of which 13 studies were included for systematic review and meta\u2010analysis. Results of the meta\u2010analysis demonstrated that the prevalence of neutropenia in newly diagnosed and untreated patients with Graves\u2019 hyperthyroidism was 10% (CI 5%\u201019%, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> 88.6%) and summary mean ANC value in neutropenic was 1.4\u00a0\u00b1\u00a00.3\u00a0\u00d7\u00a010<jats:sup>9<\/jats:sup>\/L. In all neutropenic patients under ATD therapy neutropenia resolved, thus without the worsening of the baseline ANC values or the development of agranulocytosis. The sensitivity analyses showed similar results as those of the main analyses. For all outcomes, the publication bias was not\u00a0statistically\u00a0significant or not calculable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Graves\u2019 disease per se is associated with neutropenia in about 10% of cases. Neutropenia usually appears as a <jats:italic>mild<\/jats:italic> to <jats:italic>moderate<\/jats:italic> laboratory abnormality with no detectable consequences. <jats:italic>Subnormal\/mild<\/jats:italic> neutropenia should not be regarded as a contraindication to use ATDs, and clinicians should know that treating hyperthyroidism they have a significant chance to normalize ANC too.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14313","type":"journal-article","created":{"date-parts":[[2020,8,16]],"date-time":"2020-08-16T16:10:40Z","timestamp":1597594240000},"page":"473-483","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Neutropenia in patients with hyperthyroidism: Systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2972-9551","authenticated-orcid":false,"given":"Lorenzo","family":"Scappaticcio","sequence":"first","affiliation":[{"name":"Unit of Endocrinology and Metabolic Diseases University of Campania \"L. 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