- 期刊
Antithyroid Drug Contributed to Non-Agranulocytosis, Predominantly Severe Anemia: A Case Report and Review of Literature
抗甲狀腺藥物引起之無顆粒白血球缺乏症之重度貧血：一病例報告及文獻回顧
摘要
無顆粒白血球缺乏症之重度貧血是甲硫咪唑（methimazole, MMI）的極其罕見的副作用。顆粒白血球缺乏症（agranulocytosis）已知是抗甲狀腺藥物（antithyroid drugs, ATD）引起的罕見但卻是嚴重的副作用。如果全血球減少症（pancytopenia）患者併有骨髓細胞過少即是再生不良性貧血（aplastic anemia）。抗甲狀腺藥物引起之全血球減少症、再生不良性貧血及溶血性貧血比顆粒白血球缺乏症更是罕見，至今文献上報告只有幾十例由ATD引起的再生不良性貧血及數例溶血性貧血，而且文献報告之所有由ATD引起的全血球減少症及再生不良性貧血之病例皆有顆粒白血球缺乏症。至今文献上因ATD引起的無顆粒白血球缺乏症之重度貧血的病例報告非常稀少。一位在例行健康查發現重度貧血（血紅素6.7gm/dL）的病人。病史顯示他已服用MMI及propranolol二十九天，其貧血雖併有輕度血小板缺乏及輕度白血球缺乏，但並無顆粒白血球缺乏症。此病人於停止服用MMI及propranolol一周後其貧血就已見改善（血紅素9.0gm/dL），血小板缺乏及白血球缺乏也明顯改善。這名患者後來也發現有維生素B12缺乏。唯因其貧血於停用MMI及propranolol一周後且未經維生素B12治療即已見改善，推斷MMI治療為其貧血之主要原因。雖然非常罕見，甲狀腺亢進病人於ATD治療中可能發生無顆粒白血球缺乏症之貧血。建議甲狀腺亢進病人於ATD治療中若發生貧血應立即停止ATD治療並尋找貧血之其他原因，並建議病人接受放射碘治療或甲狀腺切除術。貧血之其他原因亦應予以治療。
關鍵字
無資料並列摘要
Agranulocytosis is a serious, though rare, side effect of antithyroid drugs (ATD) treatment. Pancytopenia, aplastic anemia and hemolytic anemia are even rarer than agranulocytosis. Predominantly severe anemia without agranulocytosis contributed by ATD has been very seldom reported before. A 39-year-old man with hyperthyroidism was found to have severe anemia, mild thrombocytopenia and mild leukopenia without agranulocytosis after treatment with methimazole (MMI) and propranolol for 29 days. The predominantly severe anemia, pancytopenia improved in one week after discontinuation of MMI and propranolol treatment. This patient was later found to have concomitant vitamin B12 deficiency. This case of severe anemia not associated with agranulocytosis was likely contributed by MMI treatment. Both discontinuation of ATD therapy and search for other etiologies of anemia should be made without delay. Any other etiologies of anemia should also be corrected.