{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:15Z","timestamp":1784557035934,"version":"3.55.0"},"reference-count":14,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,9,4]]},"abstract":"A 51 year old man presented with sepsis in the setting of thioamide-induced agranulocytosis. Empiric broad-spectrum antibiotics was followed by directed narrow-spectrum antibiotics, and his neutrophil count recovered with support from granulocyte-colony stimulating factor (G-CSF) analogue transfusions. After a brief period of multi-modal therapy for nine days including potassium iodide (Lugol\u2019s iodine), cholestyramine, propanolol and lithium to temper his persisting hyperthyroidism, a total thyroidectomy was performed while thyroid hormone levels remained at thyrotoxic levels. Postoperative recovery was uncomplicated and he was discharged home on thyroxine. There is limited available evidence to guide treatment in this unique cohort of patients who require prompt management to avert impending clinical deterioration. This case report summarises the successful emergent control of thyrotoxicosis in the setting of thioamide-induced agranulocytosis complicated by sepsis, and demonstrates the safe use of multi-modal pharmacological therapies in preparation for total thyroidectomy.<\/jats:p>\n \n Learning points:<\/jats:title>\n \n \n Thioamide-induced agranulocytosis is an uncommon but potentially life-threatening complication of which all prescribers and patients need to be aware.<\/jats:p>\n <\/jats:list-item>\n \n A multi-modal preoperative pharmacological approach can be successful, even when thioamides are contraindicated, when needing to prepare a thyrotoxic patient for semi-urgent total thyroidectomy.<\/jats:p>\n <\/jats:list-item>\n \n There is not enough evidence to confidently predict the safe timing when considering total thyroidectomy in this patient cohort, and therefore it should be undertaken when attempts have first been made to safely reduce thyroid hormone levels.<\/jats:p>\n <\/jats:list-item>\n \n Thyroid storm is frequently cited as a potentially severe complication of thyroid surgery undertaken in thyrotoxic patients, although the evidence does not demonstrate this as a common occurrence.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-17-0071","type":"journal-article","created":{"date-parts":[[2017,9,3]],"date-time":"2017-09-03T05:35:35Z","timestamp":1504416935000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Thyroidectomy for the treatment of Graves\u2019 thyrotoxicosis in thioamide-induced agranulocytosis and sepsis"],"prefix":"10.1530","volume":"2017","author":[{"given":"Colin L","family":"Knight","sequence":"first","affiliation":[{"name":"1Department of Endocrinology and Diabetes, University Hospital Geelong, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamil D","family":"Cooray","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology and Diabetes, University Hospital Geelong, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaideep","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology and Diabetes, University Hospital Geelong, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Borschmann","sequence":"additional","affiliation":[{"name":"2Ear, Nose and Throat, Head and Neck Surgery, St. John of God Hospital, Geelong, Victoria, Australia"},{"name":"3Director of Otolaryngology, University Hospital Geelong, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Kotowicz","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology and Diabetes, University Hospital Geelong, Geelong, Victoria, Australia"},{"name":"4Deakin University School of Medicine, Geelong, Victoria, Australia"},{"name":"5Melbourne Clinical School-Western Campus, Department of Medicine, The University of Melbourne, St. Albans, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"key20170905131823949_bib1","doi-asserted-by":"crossref","first-page":"2544","DOI":"10.1001\/jama.2015.16535","article-title":"Management of graves disease: a review","volume":"314","author":"Burch","year":"2015","journal-title":"JAMA"},{"key":"key20170905131823949_bib2","doi-asserted-by":"crossref","first-page":"4776","DOI":"10.1210\/jc.2013-2569","article-title":"Analysis of 754 cases of antithyroid drug-induced agranulocytosis over 30 years in Japan","volume":"98","author":"Nakamura","year":"2013","journal-title":"Journal of Clinical Endocrinology Metabolism"},{"key":"key20170905131823949_bib3","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1056\/NEJM197803232981202","article-title":"Thyroid function after surgical treatment of thyrotoxicosis. 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