A 34-year-old Filipino with Graves' disease on methimazole came in due to fever, sore throat and jaundice. Patient was initially diagnosed with methimazole induced agranulocytosis and drug induced liver injury. She was treated with intravenous broad spectrum antibiotic and granulocyte colony stimulating factor. On day 4 of admission, patient had pancytopenia and was managed as methimazole induced aplastic anemia and was started on steroid therapy and 1 unit of packed red blood cell was transfused. The jaundice also increased hence she was given ursodeoxycholic acid. On day 9 of admission, with the consideration of "lineage steal phenomenon," biopsy was done and eltrompobag was started. Patient was discharged stable at 12th day of hospital admission. This case presents the 3 rarest, life threatening complication of methimazole: agranulocytosis, aplastic anemia and hepatitis. 

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Anemia ; Agranulocytosis ; Methimazole ; Antithyroid Agents

BACKGROUND: Endocrine malignancy in the Filipino population has not been well documented particularly on the incidence, prevalence, demographic profile and survival rate. It is the aim of this study to determine the prevalence rate and demographic profile of all endocrine malignancies diagnosed at a tertiary hospital.
MATERIALS AND METHODS: This is a retrospective study from March 2003 to March 2008. Data were obtained from the Tumour Registry of St. Luke's Medical Center Cancer Institute (SLMC-CI) and from the Annual Report of the Diabetes, Thyroid and Endocrinology Center (DTEC) Section of SLMC-Quezon City. Only individuals with retrievable histopathology at this institution were included in the study.
STATISTICAL ANALYSIS: Data were calculated using percentages and proportions.
RESULTS: There were a total of 855 cases of endocrine malignancies documented in five years of which, 833 were cases of thyroid malignancies (97.4%). Fourteen cases of adrenal cancer (1.60%), seven cases of neuroendocrine carcinoma (0.79%), and one case of parathyroid carcinoma (0.14%). There was no note of pituitary cancer. There were a total of 833 newly diagnosed thyroid cancer: 652 papillary carcinoma (78.2%), 157 follicular carcinoma (18.8%), 11 anaplastic carcinoma (1.32%); nine medullary thyroid cancer (1.08%); two thyroid lymphoma (0.28%), one poorly differentiated carcinoma (0.14%) and one metastatic to the thyroid (0.14%). Among the 14 adrenal cancers, seven cases were due to adrenal cortical carcinoma, one case was due to adrenal neuroblastoma and six cases were due to adrenal metastases. Among the neuroendocrine carcinomas, four were pancreatic neuroendocrine carcinoma which included two malignant insulinoma and three patients were extra pancreatic neuroendocrine carcinoma.

Human ; Male ; Female ; Aged ; Middle Aged ; Parathyroid Neoplasms ; Pituitary Neoplasms ; Thyroid Neoplasms ; Adenocarcinoma, Follicular ; Adrenal Gland Neoplasms ; Carcinoma, Neuroendocrine ; Diabetes Mellitus