{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:17:56Z","timestamp":1783448276703,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":165,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>For half a century, antithyroid drugs (ATDs) have been the first-line treatment for Graves\u2019 disease. ATDs, e.g. carbimazole, are associated with minor and serious adverse effects. These include rash, urticaria, arthralgia, hepatotoxicity, vasculitis, and agranulocytosis. Agranulocytosis is a potentially serious adverse effect characterised by a neutrophil count &amp;lt;0.5 \u00d7 109 cells\/L, which may deteriorate further into sepsis and death. This is a case report of a 47-year-old female who had a 17-year history of Graves\u2019 disease. She received carbimazole for 2 years, which was stopped after remission. She presented with relapsed thyrotoxicosis in 2025 when carbimazole (40 mg) was reinstituted. Three weeks later, the patient self-presented to the hospital with sore throat, painful swallowing, and sweating. Examination found oral ulceration, pharyngeal erythema, and tender cervical lymphadenopathy. She was admitted to the hospital and treated under the endocrinology team as agranulocytosis, carbimazole was stopped, and she was treated per local guidelines of neutropenic sepsis. After agranulocytosis was resolved, the patient underwent total thyroidectomy. Despite being well-tolerated, doctors and patients should be well aware of this potentially serious adverse effect of carbimazole.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1530\/edm-25-0131","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T18:20:19Z","timestamp":1774549219000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["Severe agranulocytosis in patient with Graves\u2019 disease on second exposure to carbimazole"],"prefix":"10.1530","volume":"2026","author":[{"given":"Hady M","family":"Gad","sequence":"first","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0826-5471","authenticated-orcid":true,"given":"Ammar W","family":"Ashor","sequence":"additional","affiliation":[{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3196-0624","authenticated-orcid":true,"given":"Waqar","family":"Ahmad","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Hanafy","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barkavi","family":"Dhakshinamoorthy","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael","family":"Elsaify","sequence":"additional","affiliation":[{"name":"3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Ashwell","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"2026070713542396500_bib1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s11154-023-09848-8","article-title":"The genetics of Graves\u2019 disease","volume":"25","author":"Grixti","year":"2024","journal-title":"Rev Endocr Metab Disord"},{"key":"2026070713542396500_bib2","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.eprac.2024.12.012","article-title":"Management aspects of medical therapy in Graves disease","volume":"31","author":"Shah","year":"2025","journal-title":"Endocr Pract"},{"key":"2026070713542396500_bib3","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"},{"key":"2026070713542396500_bib4","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s40268-017-0172-1","article-title":"Antithyroid drug-induced agranulocytosis: state of the art on diagnosis and management","volume":"17","author":"Vicente","year":"2017","journal-title":"Drugs R D"},{"key":"2026070713542396500_bib5","doi-asserted-by":"crossref","first-page":"657","DOI":"10.7326\/0003-4819-146-9-200705010-00009","article-title":"Systematic review: agranulocytosis induced by nonchemotherapy drugs","volume":"146","author":"Andersohn","year":"2007","journal-title":"Ann Intern Med"},{"key":"2026070713542396500_bib6","article-title":"Non-chemotherapy drugs inducing agranulocytosis: a disproportionality analysis based on the FAERS database","volume":"16","author":"Wu","year":"2025","journal-title":"Front Pharmacol"},{"key":"2026070713542396500_bib7","volume":"29","author":"Gulfam","year":"2017","journal-title":"Endocrine Abstracts"},{"key":"2026070713542396500_bib8","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-46307-5","article-title":"Antithyroid drug-induced leukopenia and G-CSF administration: a long-term cohort study","volume":"13","author":"Kamitani","year":"2023","journal-title":"Sci Rep"},{"key":"2026070713542396500_bib9","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1159\/000367990","article-title":"Patient knowledge of antithyroid drug-induced agranulocytosis","volume":"3","author":"Robinson","year":"2014","journal-title":"Eur Thyroid J"},{"key":"2026070713542396500_bib10","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13044-021-00109-x","article-title":"How to use thionamide anti-thyroid drug in the young\u2013what\u2019s new?","volume":"14","author":"Cheetham","year":"2021","journal-title":"Thyroid Res"}],"container-title":["Endocrinology, Diabetes &amp; 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