Marta Gutierrez Andreu (Madrid / ES), Pedro Yuste (Madrid / ES), Alejandro Moreno Bargueiras (Madrid / ES), Javier Guadarrama Gonzalez (Madrid / ES), Daniel Pastor-Altaba (Madrid / ES), Julia Bernal Tirapo (Madrid / ES), Almudena Martinez Pozuelo (Madrid / ES), Carmen Sanchez (Madrid / ES), Nicolás Pareja Arico (Madrid / ES), Silvia Fernández Noel (Madrid / ES), Eduardo Ferrero-Herrero (Madrid / ES)
Abstract text (incl. references and figure legends)
Case history
A 45-year-old woman admitted for fever of 39ºC,odynophagia and otalgia. Personal history of hyperthyroidism due to Graves Basedow disease in treatment with antithyroid
Clinical findings
Blood pressure: 120/80 mmHg,heart rate: 120 bpm
No submandibular or cervical adenopathies were palpable.Pharyngeal hyperemia without lesions in the oral cavity.Mild exophthalmos.
Systematic urine and chest X-ray normal.
Laboratory tests:absolute neutropenia,TSH <0.005ulU/ml, free T3 8.83 pg/ml, free T4 3.66 ng/dl.Positive anti-TSH receptor and anti-TPO antibodies
Results
Antithyroid treatment is discontinued.Start with empirical antibiotic treatment,granulocyte colony-stimulating factor human, corticosteroids and beta-blockers
Diagnosis
Agranulocytosis,febrile neutropenia secondary to antithyroid treatment in hyperthyroidism due to Graves Basedow's disease
Therapy and progressions
Plasmapheresis are performed prior to surgery
Urgent total thyroidectomy, visualizing 4 parathyroid glands and both recurrent laryngeal nerves with positive monitoring before and after exeresis. No post-surgical complications
Hospital discharge:descending course of corticosteroids, Euthyrox. Regular analytics
Comments
In exceptional cases urgent surgical treatment of total thyroidectomy is necessary.Urgent hyperthyroidism surgery requires rapid pre-surgical optimization,plasmapheresis and is effective,safe and with results similar to elective treatment
References
Outcomes After Urgent Thyroidectomy Following Rapid Control of Thyrotoxicosis in Graves' Disease are Similar to Those After Elective Surgery in Well-Controlled Disease. Adibah Ali , Miguel Debono , Sabapathy P Balasubramanian . World J Surg. 2019 Dec;43(12):3051-3058
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