BMJ Case Reports 2017; doi:10.1136/bcr-2017-220924
  • Reminder of important clinical lesson

Increased risk for thionamide-induced agranulocytosis in elderly patients: a case presentation and literature review

  1. Vinuta Mohan2
  1. 1Department of Internal Medicine, St Francis Medical Center, Seton Hall University, Trenton, New Jersey, USA
  2. 2Department of Endocrinology, St Francis Medical Center, Seton Hall University, Trenton, New Jersey, USA
  1. Correspondence to Dr Sumera Bukhari, doc.smbk{at}
  • Accepted 23 June 2017
  • Published 17 July 2017


Thionamides, such as methimazole and propylthiouracil, are used for the management of hyperthyroidism. Agranulocytosis is a rare adverse effect of thionamides and elderly patients are especially vulnerable. Here we discuss a case of an 80-year-old woman who developed agranulocytosis and pneumonia approximately 4 weeks after starting low dose methimazole therapy. Despite aggressive treatment with broad-spectrum antibiotics and granulocyte colony stimulating factor, she developed multiorgan failure and died. Our goals are to identify risk factors common to elderly patients and hopefully improve outcomes in this population when prescribed thionamides.


  • Contributors All authors made substantial contribution to the conception, design and revision of the draft. SB and VM reviewed all the clinical data, compiled it as a case report, reviewed the literature and were responsible for obtaining the radiological and haematological images. MK and NK helped in gathering patient's data as well as got the consent form.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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