Otterbein University Digital Commons @ Otterbein

Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work

Summer 2015

Antithyroid Drug-Induced

Elizabeth Spears Otterbein University, [email protected]

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Part of the Hemic and Lymphatic Diseases Commons, Medical Pathology Commons, and the Nursing Commons

Recommended Citation Spears, Elizabeth, "Antithyroid Drug-Induced Agranulocytosis" (2015). Nursing Student Class Projects (Formerly MSN). 85. https://digitalcommons.otterbein.edu/stu_msn/85

This Project is brought to you for free and open access by the Student Research & Creative Work at Digital Commons @ Otterbein. It has been accepted for inclusion in Nursing Student Class Projects (Formerly MSN) by an authorized administrator of Digital Commons @ Otterbein. For more information, please contact [email protected]. Antithyroid Drug-Induced Agranulocytosis Elizabeth Spears , R.N. Otterbein University, Westerville, Ohio Underlying Introduction Case Study Implications in References Pathophysiology Nursing Care We live in a culture that is busy and Granulocytopenia occurs in about 4 A 32-year-old female presenting to the unit As suggested in the case study, there is an Acute Medicine & Surgery identified Idrose, Alzamani. (2015). Acute and constantly on the go. With little percent and agranulocytosis occurs with a history of Graves’ disease. Presenting instance in which bone marrow and plan of treatment in hopes of emergency care for thyrotoxicosis and time to spare, often symptoms of an in about 0.3 percent of treated symptoms included: fever, tonsil enlargement suppression can occur. The suppression of minimizing the occurrence of adverse thyroid storm. Acute Medicine & alteration in bodily function are patients. with noted white secretions, thyroid bone marrow occurs in agranulocytosis affects of anti-thyroid drug treatment. Surgery pushed to the side and attribute to Although this depression of the enlargement, and anemia. Patient has been with the development of pancytopenia. Some recommended methods include Kobayashi, S., Noh, J., Mukasa, K., Kuni, the stress of everyday life. With count is reversible prescribed 15 mg of methamazole, which she When pancytopenia occurs, studies suggest supportive care and identifying Y., symptoms including nausea, fatigue, after the drug is discontinued, had been taking for 42 days. Diagnostic it is coupled with aplastic marrow, which precipitating factors. With the Wantanabe, N., Matsumoto, M., et al. weight loss, nervousness, and serious frequently testing shows a throat culture with moderate affects only the . The occurrence of agranulocytosis there is (2014). Characteristics of irritability, one may be more accompanies agranulocytosis and G- bacilli and G+ cocci. Patient was then granulocytes will the shift to the left, a possibility for fluid loss due to the agranulocytosis as an adverse effect inclined to disregard these accounts for almost al deaths treated with broad-spectrum antibiotics, causing a decrease in mature cells. This occurrence of a fever and . of symptoms, only to attribute them to related to the drugs (Rosove, vancomycin, cefoperazone sodium, and causes cytoplasmic swelling and Giving IV fluid is important to replace antithyroid drugs in the second or effects of a busy lifestyle. 1977).” sulbactam sodium. After approximately 10 irregularity in staining (Rosove, 1977). electrolytes and fluid volume loss. As later course of treatment. Thyroid, 24. The presentation of the previously With such an abundant amount of days of treatment, the patient’s labs began to The underlying cause of agranulocytosis in nurses and providers, it is important Laurberg, P., Cooper, D. (2015). listed symptoms can formulate a Americans suffering from thyroid worsen showing: globulins 56 g/ L, leukocytes antithryoid drug treatment has yet to be to monitor the patient’s intake and Antithyroid drug therapy in patients medical diagnosis of dysfunctions, it is important to 0.6 × 109/L, 0 × 109/L, platelets definitively pinpointed. output in hopes of preventing a fluid with graves’ disease. (pp. 65-78). hyperthyroidism. According to the provide ample education to 20 × 109/L, hemoglobin 97 g/dL. On Many theories suggest that the drug gains deficit. Graves Disease. New York, NY: American Thyroid Association, 20 patients on the adverse effects of approximately day 17, the patient’s condition entry through the bone marrow where Identifying precipitating factors can Springer Science and Business Media. million Americans will develop some antithyroid treatment, with the starting to improve with a noted decline in levels are to accumulate within the be done in a variety of methods. As Meyer-Gerbner, M., Benker, G., type of alteration in thyroid function desire to prevent the development temperature, blood cultures with results of leukocytes exceeding the volume of previously stated, agranulocytosis Lenderbogen, S., Olbricht, T., throughout their lifetime, and 60 of agranulocytosis, as well as granulocytes > 1000, platelets > 50,000, bone plasma. With leukocyte involvement, the occurs predominately in elderly Reinwein, D., Antithyroid drug — percent of those individuals will go minimize their risk of infection marrow with increased nucleated cells and utilization of glucose and oxygen is females with the presentation of induced agranulocytosis: Clinical undiagnosed. When a diagnosis is from opportunistic pathogens. myeloid hyperplasia (Xiao, Li, You, Qian, Wei, affected, showing a change in granulocytes sepsis. By monitoring temperature, experience with ten patients treated given, drug treatment options are This particular topic sparks my 2014). and oxygen consumption. The higher level heart rate, and blood pressure for at one institution and review of the limited. The two most common drug interest due to my personal health. of the antithyroid affects the cellular level acute changes, it will allow for literature., Journal of Endocrinological therapies include Propithiouracil Two years ago, suddenly began which extend through the erythroid cells. prevention and early diagnosis. Other Investigations, 17 (1), pp. 29-36. and Methamazole (Rosove, 1977). feeling anxious, experiencing Signs and Symptoms The leukocytes continue to be affected by diagnostic tests recommend including Nakamura, H., Miyauchi, A., Miyawaki, N., Although drug therapies are tremors, nauseated, and extreme antithyroid drug therapy, showing a sputum cultures with complaints of a Imagawa, J., (2013). Analysis of 754 beneficial in the treatment of fatigue. I proceeded to disregard decrease in the activity in nicotinamide sore throat, and chest radiographs, as cases of antithyroid drug-induced hyperthyroidism, adverse affects my body, only attribute these Signs and symptoms of thyrotoxicosis adenine dinucleotide, granule bound well as, monitoring the patients WBC agranulocytosis over 30 years in from drug therapy can occur. A symptoms to the effects of being a requiring drug therapy, predisposing one to nicotinamide adenine dinucleotide with each visit (Idrose, 2015; Tajiti & japan. Endocrinology Journals. more serious adverse affect of drug night shift nurse, and not being experiencing agranulocytosis, are often phosphate; therefore, decreasing the Noguchi, 2005). Nakamura H., Noh, J., Itoh, k., Fukata, S., therapy would be Agranulocytosis. able to always take a lunch break. symptoms that one may experience on an plasma membranes ability to fight off and Finally, as nurses we act as the last Miyauchi, A., Hamada, N., Comparison Agranulocytosis is condition in I continued to disregard the every day basis. Signs and symptoms engulf microorganisms (Rosove, 1977.) line of defense for our patient it is of methimazole and propylthiouracil which the bone morrow is not symptoms, until one day I noticed include: thyroid eye syndrome, sweating, important to provide education. By in patients with hyperthyroidism producing adequate amounts of my clothes began to fit more loosely goiters, tremors, nervousness weight loss educating patients on anti-thyroid caused by graves’ disease. The Journal neutrophils. With hyperthyroidism, and proceeded to experience a 40 palpitations, however elderly patients will Significance in drug treatment, adverse affects, and of Clinical Endocrinology, 92 (6). the prescribed antithyroid drug pound weight loss. The extreme display minimal signs and symptoms. Labs precipitating signs and symptoms, we Prevalence and impact of thyroid therapy, suppresses the bodies weight loss had occurred over a 50 results will show an elevated FT4, FT3, and a Pathophysiology as a profession can continue to limit disease. (2015). Retrieved from ability to produce mature white day period. I immediately notified suppressed TSH (Kobayashi, Noh, Mucosa, Explaining the effects of the antithyroid hormone on the thyroid gland, the number of patients experiencing www.thyroid.org blood cells, causing a drug-induced my primary care physician, Kuna, Watanabe, et.al. 2014). converting it to thyroxine, then converting to triiodothyronine. agranulocytosis. Rosove, M. (1977). Agranulocytosis and With the incidence of agranulocytosis being agranulocytosis. numerous labs were drawn, (Laurberg and Cooper, 73). The significance of the pathophysiology is antithyroid drugs. The Western rare, education on the presenting signs and “Propylthiouracil and methimazole eventually leading to the diagnosis important to practitioners and registered Journal of Medicine, 126, pp. 339-343. symptoms is often overlooked. are used widely in the treatment of of Graves’ disease. After being nurses because of the possibility of Conclusion Tajini, J., Noguchi, S. (2005). Antithyroid Agranulocytosis most commonly occurs within hyperthyroid disorders. The most diagnosed with Graves’, I was suppression of bone marrow and the drug-induced agranulocytosis: how the first few months of initiating treatment, important complication of the use of prescribed 10 mg of methamazole ability of the antithyroid drug to engulf Large amounts of Americans are has granulocyte colony-stimulating with a higher frequency in female patients these drugs is depression of the three times daily. My doctor stated cells. This limits one’s immune response experiencing symptoms of thyroid factor changed therapy? , Thyroid, 15. greater than 65 years of age (Nakamura, neutrophilic granulocyte count. that if I began experiencing a sore and ability to fight off infection. When a dysfunction and go undiagnosed. Young, C. J. (1949). Leucocyte Counts in Miyauchi, Natsukp, Imagawa, 2013). A throat to immediately notify the patient is prescribed treatment for The symptoms are what can be Prevention of Drug Agranulocytosis. patient that is experiencing agranulocytosis office and discontinue to the hyperthyroidism, it is imperative to attributed to stress of everyday life. British Medical Journal, 2(4621), 261– may remain asymptomatic with the only medication until further evaluation monitor for early signs of medication Once diagnosed, individuals are 263. indicator being a low count. with no further explanation as to reaction. If a fever, gingivitis, or sore often unaware of the harmful effects Xiao F, Li C, You L, Qian W, Wei J. However; individuals with presenting why the stated symptoms had any throat develops, therapy should of anti-thyroid drug therapy. Massive symptoms commonly include oropharyngeal importance. I began researching immediately be discontinued. If symptoms Although rare, agranulocytosis is a plasmacytosis with severe marrow infections, cervical lymphadenopathy, immediately, only to find that, are not identified at onset, opportunistic harmful side effect, which can lead suppression induced by methimazole odynophagia, malaise, and an elevated while uncommon, taking an pathogens can enter the body leading to series infections and even death. in Graves’ disease patients: case temperature. The appearance of antithyroid drug therapy could further suppression of bone marrow and By making patients aware of the report and literature review. agranulocytosis presents in the elderly as lead to dysfunction in the agranulocytosis, putting the patient at risk adverse affects and monitoring International Journal of Clinical and sepsis, skin infections, and pneumonia production of white blood cells, Study showing the incidence of granulocytosis with two different to become severely immunocompromised blood counts, the occurrence can Experimental Medicine. 2014;7(10): (Laurberg & Cooper, 2015). causing agranulocytosis. types of antithyroid treatment. (Rovove, 1977.) continue to be low. 3605-3608. ( Nakamura , H., Miyauchi , A., Miyawaki , N. , Imagawa , J . Table 3).