A 45-year-old woman with Graves' disease is being managed with carbimazole. She develops agranulocytosis. Besides stopping carbimazole, what is the IMMEDIATE next step in management?
- A Switch to propylthiouracil (PTU)
- B Start prednisolone 40 mg/day
- C Admit for broad-spectrum IV antibiotics and G-CSF ✓
- D Perform emergency thyroidectomy after beta-blocker preparation
Explanation
Agranulocytosis (ANC <500/µL) is a life-threatening complication of thionamides occurring in ~0.3% of patients. Immediate management involves hospitalization, isolation, broad-spectrum IV antibiotics to prevent sepsis, and G-CSF (granulocyte colony-stimulating factor) to accelerate neutrophil recovery. PTU should NOT be substituted as cross-reactivity of agranulocytosis between carbimazole and PTU is approximately 50%. Corticosteroids and emergency surgery are not indicated as first steps. After recovery, radioactive iodine or surgery is the definitive treatment for Graves' disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.