Endocrine Abstracts

74 year old lady with a background of rheumatoid arthritis and Felty’s syndrome was diagnosed as having Grave’s Thyrotoxicosis few months back in Australia. She was commenced on Carbimazole. She came back to UK and had repeat bloods done with GP which showed neutropenia. The levels of neutrophils were 0.01 and WCC was 0.4. She was otherwise asymptomatic, her weight had been stable and there were no concerns regarding any infection. Rest of her infectious screen including blood cultures, Respiratory screening and COVID were all negative. The cause of the neutropenia was Carbimazole. She was also on Hydroxychloroquine due to her Rheumatoid Arthritis which was stopped along with Carbimazole. After stopping her Carbimaozle, her T4 started rising and it was 45 at one point. In order to maintain euthyroidism she was started on Lugol’s iodine, potassium iodide, propranolol and colestyramine. These medications were not initiated all at once but were introduced gradually over time. She also developed AF due to her hyperthyroidism and was needing anticoagulation. She was also given filgrastim to help with the levels of neutrophils. Her thyroid functions improved, and she was transferred to ENT unit for total thyroidectomy. She had successful thyroidectomy done and was started on Levothyroxine. Previous studies have demonstrated that risk of developing agranulocytosis is higher in the first two to three months and patients aged >40. This was the classical case where she was in her 70s and recently diagnosed as having Grave’s disease. It is important to recognize the medications as a cause of neutropenia and also to look for any effects of neutropenia experienced such as infections.