Management of thyroid crisis in a patient with febrile neutropenia

Abstract

Introduction: Thyroid storm is a life-threatening complication of acute hyperthyroidism. The diagnosis of thyroid storm can only be based on its clinical manifestations, which include decreased consciousness, high fever, heart failure, diarrhea and jaundice. Antithyroid drug therapy (ATD) is one option for treating hyperthyroidism, along with surgery and radioactive iodine. ATD is thought to cause neutropenia through the agranulocytosis pathway. The most common symptoms are fever and sore throat accompanied by symptoms of a thyroid crisis. There is no specific method for predicting the appearance of febrile neutropenia caused by ATD. Routine complete blood counts in patients taking ATD should be performed. The diagnosis of febrile neutropenia due to ATD needs to be done immediately so that timely intervention can be carried out and reduce mortality. Case Presentation: a 25 years old female with thyroid crisis and febrile neutropenia. Clinical findings in the patient include fever, decreased consciousness, palpitation, excessive sweat, diarrhea, nausea and vomiting, weight loss, and the laboratory findings of leukopenia and neutropenia of (leucocyte 1.03x103/uL, neutrophil 1.90x103/ul). Ultrasonography examination of the thyroid reveals a thyroiditis image with multiple solid nodules. Blood smear examination reveals leukopenia with differential count examination of blood showed neutropenia, moderate lymphocytosis, erythrocyte hypochromic micrositer, poikilocytosis ovalocyte, teardrop cell, fragmentosist and target cell. Polychromasia and normoblast cells are not found. Conclusion: Thyroid crisis refers to the clinical findings and thyroid hormone test results. There is no specific method to predict the appearance of febrile neutropenia caused by the antithyroid drug. Frequent blood tests must be done in patients who consume antithyroid drugs.