{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T12:48:46Z","timestamp":1780058926140,"version":"3.54.0"},"reference-count":10,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"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":["Clin Med Insights Case Rep"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Antithyroid drug-induced agranulocytosis is a rare but potentially life-threatening complication, particularly in patients with limited therapeutic options. This case illustrates the complexity of managing uncontrolled thyrotoxicosis in the context of a patient with decompensated heart failure, chronic obstructive pulmonary disease (COPD), and adverse reactions to both methimazole and propylthiouracil. A 54-year-old male patient with a 2-year history of Graves\u2019 disease presented with worsening dyspnea and tachycardia in the setting of thyrotoxicosis with a TSH of 0.0007\u2009mIU\/L. He had previously developed agranulocytosis (ANC 180 cells\/\u00b5L) subsequent to treatment with methimazole, and subsequently developed febrile agranulocytosis (ANC 190\u2009cells\/\u00b5L) upon initiation of propylthiouracil, thereby exhausting all antithyroid drug options. A bridging therapy of Lugol\u2019s iodine and granulocyte colony-stimulating factor (G-CSF) was utilized, which enabled successful total thyroidectomy. Right heart catheterization confirmed the patient\u2019s suitability for surgery despite a left ventricular ejection fraction of 35%. This case highlights the importance of interdisciplinary collaboration in managing complex endocrine-cardiac-hematology presentations.<\/jats:p>","DOI":"10.1177\/11795476261446355","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T04:33:53Z","timestamp":1777350833000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Dual Antithyroid Drug-Induced Agranulocytosis in Graves\u2019 Disease With Decompensated Heart Failure: A Multidisciplinary Approach"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4621-0605","authenticated-orcid":false,"given":"Amarildo","family":"Voci","sequence":"first","affiliation":[{"name":"Regional Memorial Hospital, Fier, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3155-6875","authenticated-orcid":false,"given":"Liri","family":"Seraj","sequence":"additional","affiliation":[{"name":"Regional Memorial Hospital, Fier, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Shehu","sequence":"additional","affiliation":[{"name":"Regional Memorial Hospital, Fier, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asfloral","family":"Haxhiu","sequence":"additional","affiliation":[{"name":"Regional Memorial Hospital, Fier, Albania"},{"name":"Municipality Hospital of Lushnja, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"20","article-title":"Thyrotoxic dilated cardiomyopathy: personal experience and case collection from the literature","volume":"2020","author":"Molinaro G","year":"2020","unstructured":"Molinaro G, De Vecchis R, Badolati E, Giannattasio R. Thyrotoxic dilated cardiomyopathy: personal experience and case collection from the literature. Endocrinol Diab Metabol Case Rep. 2020;2020:20.","journal-title":"Endocrinol Diab Metabol Case Rep"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0229"},{"issue":"4","key":"e_1_3_2_4_2","article-title":"Graves\u2019 disease complicated with dilated cardiomyopathy: a multidisciplinary approach","volume":"12","author":"Alam ST","year":"2019","unstructured":"Alam ST, Zaman J. Graves\u2019 disease complicated with dilated cardiomyopathy: a multidisciplinary approach. BMJ Case Rep. 2019;12(4):e228896.","journal-title":"BMJ Case Rep"},{"key":"e_1_3_2_5_2","first-page":"275","volume-title":"Essentials of Medical Pharmacology","author":"Tripathi KD","unstructured":"Tripathi KD, ed. Essentials of Medical Pharmacology. 8th ed. 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Malays J Med Sci. 2009;16(1):25-33.","journal-title":"Malays J Med Sci"}],"container-title":["Clinical Medicine Insights: Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476261446355","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11795476261446355","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476261446355","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T03:46:25Z","timestamp":1777520785000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11795476261446355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":10,"alternative-id":["10.1177\/11795476261446355"],"URL":"https:\/\/doi.org\/10.1177\/11795476261446355","relation":{},"ISSN":["1179-5476","1179-5476"],"issn-type":[{"value":"1179-5476","type":"print"},{"value":"1179-5476","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"article-number":"11795476261446355"}}