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Hyperthyreose und akute Tonsillitis bei einer 23-jährigen Patientin

Hyperthyroid and acute tonsillitis in a 23-year-old woman

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Zusammenfassung

Eine 23-jährige Patientin mit Morbus Basedow unter Thiamazoltherapie stellte sich mit Fieber, Schluckbeschwerden, manifester Hyperthyreose und Leukopenie vor. Unter dem Verdacht auf eine thyreotoxische Krise bei medikamenteninduzierter Agranulozytose erfolgten eine Plasmapherese, die Gabe des Granulozyten-Kolonie-stimulierenden Faktors, eine Konversionshemmung und im Intervall die Thyreoidektomie. Thiamazol ist eine häufige Ursache der medikamenteninduzierten Agranulozytose. Eine Dauertherapie ist kritisch zu sehen, Therapiealternativen sollten frühzeitig erwogen werden. Die Plasmapherese ist ein probates Mittel zum Erreichen einer euthyreoten Stoffwechsellage.

Abstract

A 23-year-old woman with preexisting Graves’ disease who received thiamazole treatment presented with fever, dysphagia, hyperthyroidism and leukopenia. With suspicion of thyreotoxicosis accompanied by drug-induced agranulocytosis she was successfully managed by plasmapheresis, G‑CSF administration and inhibition of periphereal conversion of thyroid hormones. In due course she underwent thyroidectomy. Thiamazole is frequently associated with drug-induced agranulocytosis. Long-term therapy with thiamazole requires critical evaluation and alternatives should be considered early. Plasmapheresis is an adequate treatment option to achieve normal thyroid hormonal status.

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland

    G. Beyer, C. Budde, E. Wilhelm, S. Stracke, J. Mayerle & A. Steveling

  2. Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland

    I. Küster

  3. Klinik und Poliklinik für Allgemeine Chirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland

    A. Hoene

  4. Institut für Pathologie, Universitätsmedizin Greifswald, Greifswald, Deutschland

    K. Evert

  5. Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Deutschland

    S. Friesecke

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  1. G. Beyer
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  9. J. Mayerle
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  10. A. Steveling
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Correspondence to G. Beyer.

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G. Beyer, I. Küster, C. Budde, E. Wilhelm, A. Hoene, K. Evert, S. Stracke, S. Friesecke, J. Mayerle und A. Steveling geben an, dass kein Interessenkonflikt besteht.

Die Autoren versichern die Einhaltung der Deklaration von Helsinki und Beachtung der Grundlagen der guten klinischen Praxis. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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H. Haller, Hannover (Schriftleitung)

B. Salzberger, Regensburg

C. Sieber, Nürnberg

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Beyer, G., Küster, I., Budde, C. et al. Hyperthyreose und akute Tonsillitis bei einer 23-jährigen Patientin. Internist 57, 717–723 (2016). https://doi.org/10.1007/s00108-016-0044-8

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