Graves' disease in a 3 year-old patient with agranulocytosis due to anti-thyroid drugs: Radioiodine ablation therapy as an effective alternative

E Espinosa-Muñoz; D Ramírez-Ocaña; A M Martín-García; F J Ruiz-García; C Puentes-Zarzuela

doi:10.1016/j.remn.2016.12.005

Graves' disease in a 3 year-old patient with agranulocytosis due to anti-thyroid drugs: Radioiodine ablation therapy as an effective alternative

Rev Esp Med Nucl Imagen Mol. 2017 Jul-Aug;36(4):260-262. doi: 10.1016/j.remn.2016.12.005. Epub 2017 Apr 6.

[Article in English, Spanish]

Authors

E Espinosa-Muñoz¹, D Ramírez-Ocaña², A M Martín-García², F J Ruiz-García², C Puentes-Zarzuela²

Affiliations

¹ Unidad de Gestión Clínica de Medicina Nuclear, Hospital Regional Universitario de Málaga, Málaga, España. Electronic address: elenaespinosamunoz@gmail.com.
² Unidad de Gestión Clínica de Medicina Nuclear, Hospital Regional Universitario de Málaga, Málaga, España.

PMID: 28392335
DOI: 10.1016/j.remn.2016.12.005

Abstract

The case is presented of a 3 year-old girl with mitochondrial disease (subacute necrotizing encephalomyelopathy of Leigh syndrome), v-stage chronic kidney disease of a diffuse mesangial sclerosis, as well as developmental disorders, and diagnosed with hyperthyroidism Graves-Basedow disease. Six weeks after starting the treatment with neo-carbimazole, the patient reported a serious case of agranulocytosis. This led to stopping the anti-thyroid drugs, and was treated successfully with ¹³¹I ablation therapy. The relevance of the article is that Graves' disease is uncommon in the paediatric age range (especially in children younger than 6 years old), and developing complications due to a possible late diagnosis. Agranulocytosis as a potentially serious adverse effect following the use of anti-thyroid drugs, and the few reported cases of ablation therapy with ¹³¹I at this age, makes this case unique.

Keywords: (131)I; Agranulocitosis; Agranulocytosis; Anti-thyroid drugs; Enfermedad de Graves; Fármacos antitiroideos; Graves’ disease.

Publication types

Case Reports

MeSH terms

Agranulocytosis / chemically induced*
Agranulocytosis / therapy
Antithyroid Agents / adverse effects*
Antithyroid Agents / therapeutic use
Blood Transfusion
Carbimazole / adverse effects*
Carbimazole / therapeutic use
Child, Preschool
Developmental Disabilities / complications
Drug Therapy, Combination
Female
Graves Disease / complications
Graves Disease / drug therapy
Graves Disease / radiotherapy*
Humans
Iodine Radioisotopes / therapeutic use*
Leigh Disease / complications
Nephrotic Syndrome / complications
Propranolol / therapeutic use
Sclerosis / complications

Substances

Antithyroid Agents
Iodine Radioisotopes
Carbimazole
Propranolol

Supplementary concepts

Mesangial sclerosis, diffuse