Haematopoietic growth factor in antithyroid-drug-induced agranulocytosis

Drug‐induced agranulocytosis (DIA) is often caused by antithyroid drugs. We retrospectively studied the use of granulocyte colony‐stimulating factor (G‐CSF) therapy in antithyroid‐DIA. Data for 20 patients (10 treated with G‐CSF) with antithyroid‐DIA (neutrophil count <0.5×109/l) were extracted from a cohort study of DIA patients (n</it>=110). G‐CSF (300 μg/day subcutaneously) was used where the neutrophil count was <0.1×109/l, or the patient was aged >70 years, or there were severe features of infection or underlying disease. Mean patient age was 62 years (range 34–87); sex ratio (M/F) was 0.05. Carbimazole (n</it>=19) and benzylthiouracile (n</it>=1) were the causative drugs, at mean doses of 30 mg/day (range 20–60) and 100 mg/day (range 50–150), respectively, for a mean of 37 days (range 31–90). Antithyroid drugs were prescribed for Graves' disease (n</it>=8), thyrotoxicosis related to amiodarone intake (n</it>=6) and multinodular goitre (n</it>=6). Clinical features included isolated fever (n</it>=7), pneumonia (n</it>=5), septicaemia or septic shock (n</it>=5) and acute tonsillitis (n</it>=3). Mean neutrophil count was 0.07±0.1×109/l. No patient died. Mean durations of haematological recovery, antibiotic therapy and hospitalization were significantly reduced with G‐CSF: 6.8±4 days vs. 11.6±5; 7.5±3.8 days vs. 12±4.5; and 7.3±4.8 days vs. 13±6.1, respectively (all p</it><0.05). G‐CSF induced flu‐like symptoms in 30% of patients, but reduced overall costs.