The Effects of GCSF on the Recovery Time and Duration of Hospitalization in Patients with Anti-thyroid Drug-Induced Agranulocytosis in a Tertiary Hospital


  • Maria Monina Clauna-Lumanta The Medical City
  • Christy Yao The Medical City
  • Johann Fabrian Bolinao The Medical City


antithyroid drugs, agranulocytosis, granulocyte colony-stimulating factor, hyperthyroidism


Objectives. This study aims to determine if there is a significant difference in the recovery time and duration of hospital stay of patients with anti-thyroid drug-(ATD) induced agranulocytosis with and without granulocyte colony-stimulating factor (GCSF) therapy. It also aims to describe the clinical characteristics of patients who had anti-thyroid drug-induced agranulocytosis.

Methodology. This is a retrospective study of hyperthyroid patients on anti-thyroid drugs (ATD) who had an absolute neutrophil count (ANC) of less than 500/μL. Their charts were reviewed for collection of data on age, gender, body mass index (BMI), type and duration of ATD and use of antibiotic and steroid. Recovery time and length of hospital stay were compared between those who received and did not receive GCSF.

Results. TWith similar clinical features between the GCSF and non-GCSF groups, the recovery time from agranulocytosis and duration of hospitalization were significantly shorter in the GCSF group, despite lower ANC.

Conclusion. GCSF significantly decreased recovery time (4 versus 7 days, p=0.005) and duration of hospital stay (5 versus 7 days, p=0.009) of hyperthyroid patients with anti-thyroid drug-induced agranulocytosis compared to patients not given GCSF.


Download data is not yet available.

Author Biographies

Maria Monina Clauna-Lumanta, The Medical City

Graduate of Endocrinology Fellowship Training

Section of Endocrinology, Diabetes and Metabolism

Department of Medicine 

The Medical City


Active Consultant

Deparment of Medicine

New Sinai MDI Hospital

Christy Yao, The Medical City

Training Officer

Section of Endocrinology, Diabetes and Metabolism

Department of Medicine

Johann Fabrian Bolinao, The Medical City

Former Associate Head

Center for Research and Healthcare Innovation


Watanabe N, Narimatsu H, Noh JY, et al. Antithyroid drug-induced hematopoietic damage: A retrospective cohort study of agranulocytosis and pancytopenia involving 50,385 patients with Graves’ disease. J Clin Endocrinol Metab. 2012;97(1):E49-53. 10.1210/jc.2011-2221

Cooper DS. Antithyroid drugs. N Engl J Med. 2005;352(9):905-17. 10.1056/nejmra042972.

Andersohn F, Konzen C, Garbe E. Systematic review: Agranulocytosis induced by nonchemotherapy drugs. Ann Intern Med. 2007;146(9):657-65. PMID: 17470834.

Huang CH, Li KL, Wu JH, Wang PN, Juang JH. Antithyroid drug-induced agranulocytosis: Report of 13 cases. Chang Gung Med J. 2007;30(3):242-8. PMID: 17760275.

Thomas D, Moisidis A, Tsiakalos A, Alexandraki K, Syriou V, Kaltsas G. Antithyroid drug-induced aplastic anemia. Thyroid. 2008;18(10):1043-8. 10.1089/thy.2008.0097.

Nakamura H, Miyauchi A, Miyawaki N, Imagawa J. Analysis of 754 cases of anti-thyroid drug-induced agranulocytosis over 30 years in Japan. J Clin Endocrinol Metab. 2013;98(12):4776-83.

Van der Klauw MM, Goudsmit R, Halie MR, et al. A population based case-cohort study of drug-associated agranulocytosis. Arch Intern Med. 1999;159(4):369-74.

Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593-646.

Chen PL, Shih SR, Wang PW, et al. Genetic determinants of antithyroid drug-induced agranulocytosis by human leukocyte antigen genotyping and genome-wide association study. Nat Commun. 2015;6:7633. 10.1038/ncomms8633.

Cooper DS, Goldminz D, Levin A, et al. Agranulocytosis associated with antithyroid drugs: Effects of patient age and drug dose. Ann Intern Med. 1983;98(1):26-9. 10.7326/0003-4819-98-1-26.

Tajiri J, Noguchi S, Murakami T, Murakami N. Antithyroid drug-induced agranulocytosis. The usefulness of routine white blood cellcount monitoring. Arch Intern Med. 1990;150(3):621-4. 10.1001/archinte.1990.00390150107020.

Tamai H, Takaichi Y, Morita T, et al. Methimazole-induced agranulocytosis in Japanese patients with Graves' disease. Clin Endocrinol (Oxf). 1989;30(5):525-30.

Mantilla AS, Tan GH. The clinical profile of patients who developed agranulocytosis on anti-thyroid agents: Cebu Doctors’ Hospital experience. Philipp J Intern Med. 2004;42(5);251-4.

Tajiri J, Noguchi, S. Antithyroid drug-induced agranulocytosis: How has granulocyte colony-stimulating factor changed therapy? Thyroid. 2005;15(3):292-7. 10.1089/thy.2005.15.292.

Fukata S, Kuma K, Sugawara M. Granulocyte colony-stimulating factor (G-CSF) does not improve recovery from antithyroid druginduced agranulocytosis: A prospective study. Thyroid. 1999;9(1):29-31. 10.1089/thy.1999.9.29.

Andrès E, Kurtz JE, Perrin AE, Dufour P, Schlienger JL, Maloisel F. Haematopoietic growth factor in antithyroid-drug-induced agranulocytosis. QJM. 2001;94(8):423-8.

Macaballug AG, Cunanan EC, Fernando-Lopez EV. Outcome of patients with antithyroid drug induced granulocytosis admitted at the University of Santo Tomas Hospital from 2001-2007. Philipp J Intern Med. 2008;46(5): 227-31.

Tajiri J, Noguchi S, Okamura S, et al. Granulocyte colony-stimulating factor treatment of antithyroid drug-induced granulocytopenia. Arch Intern Med. 1993;153(4): 509-14.

Tamai H, Mukuta T, Matsubayashi S, et al. Treatment of methimazole-induced agranulocytosis using recombinant human granulocyte colony-stimulating factor (rhG-CSF). J Clin Endocrinol Metab. 1993;77(5):1356-60.

Hirsch D, Luboshitz J, Blum I. Treatment of antithyroid drug-induced agranulocytosis by granulocyte colony-stimulating factor: A case of primum non nocere. Thyroid. 1999;9(10):1033-5.

Smith TJ, Khatcheressian J, Lyman GH, et al. 2006 update of recommendations for the use of white blood cell growth factors: An evidence-based clinical practice guideline. J Clin Oncol. 2006;24(19):3187-205.

Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2): 489-99.

Bahn RS, Burch HS, Cooper DS, et al. The role of propylthiouracil in the management of Graves’ disease in adults: Report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. 2009;19(7):673-4.

Nakagawa M, Terashima T, D’yachkova Y, Bondy GP, Hogg JC, van Eeden SF. Glucocorticoid-induced granulocytosis: Contribution of marrow release and demargination of intravascular granulocytes. Circulation. 1998;98(21):773-8.



How to Cite

Clauna-Lumanta, M. M., Yao, C., & Bolinao, J. F. (2016). The Effects of GCSF on the Recovery Time and Duration of Hospitalization in Patients with Anti-thyroid Drug-Induced Agranulocytosis in a Tertiary Hospital. Journal of the ASEAN Federation of Endocrine Societies, 31(2), 131. Retrieved from



Original Articles