The Use of Iodine as First Line Therapy in Graves' Disease Complicated with Neutropenia at First Presentation in a Paediatric Patient

Abstract

Aims: Graves' disease is a common cause of hyperthyroidism in the paediatric population. An association between neutropenia and untreated Graves' disease has been described although the aetiology is unknown. Presentation of Case: A 13 year old boy presented with a 3 month history of weight loss, insomnia, fatigue, palpitations and anxiety. On examination, he had tachycardia of 140 beats/minute, sweating, tremors and brisk deep tendon reflexes. The clinical and laboratory results were consistent with Graves' hyperthyroidism. He was treated with Lugol`s iodine and Propanolol in view of his low neutropenia count at diagnosis. Discussion: Thionamide drugs remain the initial treatment of choice in children and adolescents presenting with Graves' disease, however adverse effects such as agranulocytosis remains a concern. Conclusion: In cases where anti-thyroid thionamides are contraindicated due to the risk of side effects such as agranulocytosis or neutropenia, Lugol's iodine may be an alternative temporary form of first line therapy.