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Antineoplastics/potassium iodide/thiamazole Neutropenia and hypothyroidism: 7 case reports

In a study of 8 patients diagnosed with Graves’ hyperthyroidism (GD) between 2004 and 2011, 7 patients (6 women and 1 man) aged 34–67 years were described, who developed neutropenia or hypothyroidism (hypothyroid) during treatment with carboplatin [CBDCA], cisplatin [CDDP], gemcitabine, gimeracil/oteracil/tegafur [TS-1; tegafur/gimeracil/oteracil], ifosfamide [IFM], irinotecan [irinotecan hydrochloride hydrate; CPT-11], paclitaxel [PTX], pemetrexed [pemetrexed sodium hydrate; PEM], thiamazole [methylmercaptoimidazole; MMI] or potassium iodide [KI] [routes and durations of treatments to reactions onsets not stated; not all dosages and outcomes stated]. Patient 1: The 40-year-old woman, who had uterus cancer, was found to have GD during check-up. She required immediate surgery for uterus cancer. Before the surgery, she received treatment with thiamazole 15mg for GD. She became euthyroid on day 31. She underwent hysterectomy. After surgery, thiamazole was switched to potassium iodide 100mg. Additionally, she started receiving chemotherapy with paclitaxel and carboplatin. She developed slight neutropenia secondary to treatment with paclitaxel and carboplatin and thiamazole. On day 486, she became hypothyroid secondary to treatment with potassium iodide with a serum free T4 (fT4) level of 0.4 ng/dL and TSH level of 40.5 µU/mL. Thus, she was treated with a combination of potassium iodide 100mg and levothyroxine sodium [synthesized L-thyroxine; LT-4]. The TSH-binding inhibitor immunoglobulin (TBII) became negative on day 6167, and she entered remission thereafter. Patient 2: The 66-year-old woman, who had lung cancer, was found to have GD during check-up. She required immediate surgery for lung cancer. Before the surgery, she received treatment with thiamazole 15mg and potassium iodide 100mg for GD and became euthyroid after 17 days. She underwent pulmonary lobectomy. After surgery, she was treated with iodine 131 [radioactive iodine; RAI] and her thiamazole and potassium iodide were stopped. She again had hyperthyroidism. So, she received treatment with potassium iodide 100mg. She started receiving chemotherapy with carboplatin and pemetrexed along with radiotherapy. She developed slight neutropenia with neutrophil count decreasing from 2960 µL to 1586 µL secondary to treatment with carboplatin, pemetrexed and thiamazole. Additionally, she became hypothyroid on days 763 after receiving iodine 131, secondary to treatment with potassium iodide. Thus, she received treatment with levothyroxine sodium. Patient 3: The 52-year-old woman, who had duodenal cancer, was found to have GD during check-up. She required immediate surgery for duodenal cancer. Before the surgery, she was treated with iodine 131, followed by potassium iodide 200mg. She became euryroid after 21 days. She underwent pancreatoduodenectomy and started receiving chemotherapy with gemcitabine, cisplatin and gimeracil/oteracil/tegafur. She developed repeated neutropen