Life Saving Cure, Harmful Turn: PTU-Induced Neutropenia in a Patient with Thyroid Storm

Abstract

Though it stands as the first line and life-saving therapeutic option in thyroid storms, Propylthiouracil (PTU) remains a double-edged sword, fraught with rare yet potentially life-threatening adverse effects. This case report underscores PTU-induced neutropenia in a 34-year-old Saudi female with a two-year history of Grave’s disease. Having ceased antithyroid medications on her own accord and being in the third month postpartum, these factors together served as sufficient catalysts to precipitate a severely symptomatic thyrotoxic crisis. The patient was managed with supportive care, hydrocortisone, propranolol, and PTU; yet on the fourth day following admission to the intensive care unit, her neutrophil count plummeted precipitously, indicating severe PTU-induced neutropenia, thereby rendering PTU permanently contraindicated. This case report illustrates that management of thyroid storm remains achievable without PTU; however, definitive treatment ultimately necessitates thyroidectomy, particularly when radioactive iodine is contraindicated, as was the case here owing to the postpartum state.