Q:

How do we monitor for adverse effects of antithyroid drugs?

waelhammad
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2022-11-18
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A 30-year-old woman presents with complaints of palpitations, tremulousness and weight loss of around 4 kg (despite a good appetite) over the last 2 months. On examination, she is anxious, has a pulse rate of 100/min, warm and moist peripheries, fine tremors of the outstretched hands and a visible goiter. No obvious abnormalities in the eyes. Her last menstrual period was 15 days ago. Her primary care physician orders for laboratory examination which reveals normal hemogram with an erythrocyte sedimentation rate of 25 mm in the first hour. Thyroid stimulating hormone (TSH) <0.001 mIU/L and total T4 28 mg/dL. A diagnosis of thyrotoxicosis is made. She is started on beta-blockers and she is asked to get a technetium uptake scan and review.

How do we monitor for adverse effects of antithyroid drugs?

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waelhammad
2022-11-18
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Most patients who develop agranulocytosis are symptomatic, hence a differential white blood cell count should be obtained during febrile illness and at the onset of pharyngitis in all patients taking antithyroid medication. Similarly, liver function should be assessed in patients who experience pruritic rash, jaundice, light-colored stool or dark urine, joint pain, abdominal pain or bloating, anorexia, nausea, or fatigue. There is insufficient evidence to recommend for or against routine monitor-ing of WBC counts and liver function tests in patients taking ATDs.

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