{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T21:41:59Z","timestamp":1771623719038,"version":"3.50.1"},"reference-count":18,"publisher":"The Endocrine Society","issue":"2","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Antithyroid drug (ATD)-induced agranulocytosis is a rare but potentially life-threatening adverse effect. We report the case of a 51-year-old man who developed agranulocytosis after reinitiating treatment with low-dose thiamazole, which was complicated by right buccal cellulitis, leading to thyroid storm. He was diagnosed with Graves disease 4 years earlier and treated with thiamazole; however, he discontinued the treatment on his own after 1 year. Due to the recurrence of Graves disease, 5\u2005mg of thiamazole was reinitiated. Thirty-five days later, thyroid storm occurred, owing to right buccal cellulitis with thiamazole-induced agranulocytosis. Thiamazole can induce agranulocytosis, even at low doses and when reinitiated, regardless of prior tolerance. This case emphasizes that prior tolerance to thiamazole does not preclude the possibility of life-threatening adverse events upon reinitiation, even at minimal doses. Even in the absence of adverse effects during the initial course of ATD therapy, physicians should remain vigilant for ATD-related adverse effects when reinitiating treatment, even at low doses, particularly after a prolonged discontinuation period. Given the severity of agranulocytosis, patient education at the time of prescription is crucial for the early recognition of symptoms, such as fever or sore throat, which may enable timely diagnosis and appropriate intervention.<\/jats:p>","DOI":"10.1210\/jcemcr\/luaf330","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:07:57Z","timestamp":1765544877000},"source":"Crossref","is-referenced-by-count":1,"title":["Severe Agranulocytosis and Thyroid Storm Triggered by Reinitiating Low-Dose Thiamazole: A Cautionary Case"],"prefix":"10.1210","volume":"4","author":[{"given":"Yuki","family":"Minamoto","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Osaka City General Hospital , Osaka 534-0021, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenta","family":"Amemiya","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Osaka City General Hospital , Osaka 534-0021, Japan"},{"name":"Department of Diabetes and Endocrinology, Hyogo Prefectural Amagasaki General Medication Center, Hyogo 660-8550 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yui","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Osaka City General Hospital , Osaka 534-0021, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yumiko","family":"Sasai","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Osaka City General Hospital , Osaka 534-0021, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9099-7673","authenticated-orcid":false,"given":"Keiko","family":"Yamagami","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Osaka City General Hospital , Osaka 534-0021, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4541-0981","authenticated-orcid":false,"given":"Naotetsu","family":"Kanamoto","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Osaka City General Hospital , Osaka 534-0021, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"issue":"9","key":"2026020411150719400_luaf330-B1","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1056\/NEJMra042972","article-title":"Antithyroid drugs","volume":"352","author":"Cooper","year":"2005","journal-title":"N Engl J Med"},{"issue":"6","key":"2026020411150719400_luaf330-B2","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1210\/jc.2006-2135","article-title":"Comparison of methimazole and propylthiouracil in patients with hyperthyroidism caused by Graves\u2019 disease","volume":"92","author":"Nakamura","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2026020411150719400_luaf330-B3","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1089\/thy.2008.0364","article-title":"Methimazole-induced agranulocytosis in patients with Graves\u2019 disease is more frequent with an initial dose of 30 mg daily than with 15 mg daily","volume":"19","author":"Takata","year":"2009","journal-title":"Thyroid"},{"issue":"2","key":"2026020411150719400_luaf330-B4","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1517\/17425255.2015.985649","article-title":"Current understanding of the mechanisms of idiosyncratic drug-induced agranulocytosis","volume":"11","author":"Johnston","year":"2015","journal-title":"Expert Opin Drug Metab Toxicol"},{"issue":"12","key":"2026020411150719400_luaf330-B5","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1507\/endocrj.EJ16-0336","article-title":"2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition)","volume":"63","author":"Satoh","year":"2016","journal-title":"Endocr J"},{"issue":"2","key":"2026020411150719400_luaf330-B6","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0889-8529(18)30165-8","article-title":"Life-threatening thyrotoxicosis. 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