{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T17:32:22Z","timestamp":1773682342279,"version":"3.50.1"},"reference-count":29,"publisher":"FapUNIFESP (SciELO)","issue":"6","license":[{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  INTRODUCTION: Graves\u2019 disease (GD) is an autoimmune disorder characterized by hyperthyroidism. Antithyroid drugs (ATDs) are available as therapy. Agranulocytosis is a rare but potentially fatal complication of this therapy. In this study, we report agranulocytosis induced by propylthiouracil (PTU) in a patient with GD and the difficulties of clinical management.  CASE: RNBA, male, 30 years old, with GD, treated with propylthiouracil (PTU). He progressed with pharyngotonsillitis. Then, PTU was suspended and antibiotic, filgrastim, propranolol, and prednisone were initiated. Due to the decompensation of hyperthyroidism, lithium carbonate, dexamethasone, and Lugol's solution were introduced. Total thyroidectomy (TT) was performed with satisfactory postoperative progression.  DISCUSSION: We describe here the case of a young male patient with GD. For the treatment of hyperthyroidism, thioamides are effective options. Agranulocytosis induced by ATDs is a rare complication defined as the occurrence of a granulocyte count &lt;500\/mm3 after the use of ATDs. PTU was suspended, and filgrastim and antibiotics were prescribed. Radioiodine (RAI) or surgery are therapeutic alternatives. Due to problems with ATD use, a total thyroidectomy was proposed. The preoperative preparation was performed with beta-blocker, glucocorticoid, lithium carbonate, and Lugol solution. Cholestyramine is also an option for controlling hyperthyroidism. TT was performed without postoperative complications.  CONCLUSION: Thionamide-induced agranulocytosis is a rare complication. With a contraindication to ATDs, RAI and surgery are definitive therapeutic options in GD. Beta-blockers, glucocorticoids, lithium carbonate, iodine, and cholestyramine may be an adjunctive therapy for hyperthyroidism.<\/jats:p>","DOI":"10.1590\/1806-9282.65.6.755","type":"journal-article","created":{"date-parts":[[2019,7,20]],"date-time":"2019-07-20T15:05:44Z","timestamp":1563635144000},"page":"755-760","source":"Crossref","is-referenced-by-count":7,"title":["Propylthiouracil-induced agranulocytosis as a rare complication of antithyroid drugs in a patient with Graves\u2019 disease"],"prefix":"10.1590","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8085-9581","authenticated-orcid":false,"given":"Patr\u00edcia Novais","family":"Rabelo","sequence":"first","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4122-1198","authenticated-orcid":false,"given":"Paula Novais","family":"Rabelo","sequence":"additional","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8936-5169","authenticated-orcid":false,"given":"Allyne Fernanda de","family":"Paula","sequence":"additional","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0796-6708","authenticated-orcid":false,"given":"Samuel Amanso da","family":"Concei\u00e7\u00e3o","sequence":"additional","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0546-8772","authenticated-orcid":false,"given":"Daniela Pultrini Pereira de Oliveira","family":"Viggiano","sequence":"additional","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4098-5273","authenticated-orcid":false,"given":"Daniela Esp\u00edndola","family":"Antunes","sequence":"additional","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2882-5974","authenticated-orcid":false,"given":"Estela Muszkat","family":"Jatene","sequence":"additional","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2593-7505","authenticated-orcid":false,"given":"S\u00edlvia Leda Fran\u00e7a Moura de","family":"Paula","sequence":"additional","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3879-7185","authenticated-orcid":false,"given":"Monike Louren\u00e7o","family":"Dias","sequence":"additional","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1792-0754","authenticated-orcid":false,"given":"Maria Aparecida Lopes","family":"Reis","sequence":"additional","affiliation":[{"name":"Federal University of Goi\u00e1s,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2019,6]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"7633","DOI":"10.1038\/ncomms8633","article-title":"Genetic determinants of antithyroid drug-induced agranulocytosis by human leukocyte antigen genotyping and genome-wide association study","volume":"6","author":"Chen PL","year":"2015","journal-title":"Nat Commun"},{"issue":"4","key":"ref2","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1210\/edrv-10-4-537","article-title":"The causes of autoimmune thyroid disease","volume":"10","author":"DeGroot LJ","year":"1989","journal-title":"Endocr Rev"},{"key":"ref3","series-title":"Endotext","volume-title":"Diagnosis and treatment of Graves\u2019 disease","author":"DeGroot LJ","year":"2012"},{"issue":"12","key":"ref4","doi-asserted-by":"crossref","first-page":"4873","DOI":"10.1210\/jc.2006-1402","article-title":"Influences of age, gender, smoking, and family history on autoimmune thyroid disease phenotype","volume":"91","author":"Manji N","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"issue":"10","key":"ref5","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1089\/thy.2016.0229","article-title":"American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis","volume":"26","author":"Ross DS","year":"2016","journal-title":"Thyroid"},{"issue":"3","key":"ref6","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1001\/archinte.1990.00390150107020","article-title":"Antithyroid drug-induced agranulocytosis. 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