ArticleInternational medical case reports journal2026
Propylthiouracil Induced Neutropenia in Thyroid Storm: A Case Requiring Urgent Total Thyroidectomy.
Article in International medical case reports journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Thyroid storm is a rare but life-threatening complication of hyperthyroidism that requires urgent management. While propylthiouracil (PTU) is a key treatment, it carries multiple risks, including potentially fatal risk of agranulocytosis. We report a 40-year-old female with Graves' disease who presented with thyroid storm and compressive goiter. High-dose PTU (1 g loading dose followed by 200 mg every 4 hours) was initiated; however, severe neutropenia (ANC: 0.22×10ˆ3/µL) developed within 48 hours, necessitating immediate drug discontinuation. Bridging therapy with hydrocortisone, cholestyramine, Lugol's solution, was implemented once available, and low-dose carbimazole was cautiously reintroduced under close monitoring without recurrence of neutropenia. Once a euthyroid state was achieved, definitive management with a total thyroidectomy was performed without complications. This case highlights three key learning points: (1) agranulocytosis can occur very early during high-dose PTU therapy; (2) careful bridging strategies are essential to prevent rebound thyroid storm after antithyroid drug withdrawal; and (3) timely transition to definitive surgical management can be lifesaving when antithyroid drug intolerance occurs.
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