疑似Methimazole引起之顆粒性白血球缺乏症之案例報告

口服抗甲狀腺藥物（antithyroid drugs）是最常被廣泛用於甲狀腺亢進之治療，長期使用下是相當安全的藥物，但該類藥物有一罕見且危及生命的藥物不良反應（adverse drug reaction），即顆粒性白血球缺乏症（agranulocytosis），此藥物不良反應大多發生於使用口服抗甲狀腺藥物後三至四個月。本案例為22歲女性，使用methimazole 25天後發生間歇性發燒、喉嚨痛以及口腔潰瘍等症狀，抽血報告顯示白血球（white blood cells）1,200/μL、絕對嗜中性白血球數目（absolute neutrophil count）12/μL，醫師當下懷疑可能是methimazole引起之顆粒性白血球缺乏症，立即停藥並給予顆粒性白血球群落刺激因子（granulocyte colony-stimulating factor）及廣效型抗生素作為治療，顆粒性白血球缺乏症於9天後獲得改善。藉由報導此案例並探討抗甲狀腺藥物引起顆粒性白血球缺乏症之相關因子與機轉，以期透過本案例提醒醫療人員加強衛教患者留意顆粒性白血球缺乏症之相關症狀。

關鍵字

抗甲狀腺藥物； methimazole ；顆粒性白血球缺乏症；藥物不良反應

並列摘要

Oral antithyroid drugs are the most commonly used treatment for hyperthyroidism and quite safe for long-term use, but these drugs have a rare and life-threatening adverse drug reactions. It is agranulocytosis and usually occurs 3-4 months after the use of oral antithyroid drugs. This case was a 22-year-old female, who developed intermittent fever, sore throat, and oral ulcers after she took methimazole for 25 days. The blood test report showed white blood cells 1,200/μL and absolute neutrophil count 12/μL. The physician suspected that it might be agranulocytosis deficiency caused by methimazole and discontinued methimazole immediately. Granulocyte colony-stimulating factor and broad-spectrum antibiotics were given as treatment and agranulocytosis were improved after 9 days. Through this case report, we explored the related factors and mechanisms of agranulocytosis induced by antithyroid drugs and hope to remind medical staffs to strengthen health education for patients to pay attention to the related symptoms of agranulocytosis.

並列關鍵字

Antithyroid Drugs ； Methimazole ； Agranulocytosis ； Adverse Drug Reaction

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