Physicians' and Patients' Perceptions and Practices Concerning Antithyroid Drug-Induced Agranulocytosis

Abstract

Objectives We aimed to ascertain physicians' attitudes and practices and evaluate patients' knowledge of antithyroid drugs (ATDs). Also, we would like to review the quality of patients' information on the Internet (in Arabic) concerning ATDs' including agranulocytosis.

Methods A mixed methods study design was employed, including an online physician questionnaire, structured interviews of patients on ATDs, and evaluation on web sites containing patients' information in Arabic.

Results Most physicians (82.6%) thought the frequency of agranulocytosis in patients receiving antithyroid medications is 1 to 5 per 1,000 per annum. Nearly 72% of the participants reported educating their patients about the risk of agranulocytosis when they receive ATDs regularly verbally only. Most physicians thought patients should be warned about sore throat and fever. More participants would measure a white blood cell (WBC) count only if a patient developed suggestive symptoms (57.0%) than those who do it routinely (43.0%). If a patient receiving ATDs develops suspicious symptoms, participants thought that the most efficient way to deal with this is to attend the nearest hospital emergency department (37.2%). Less thought they can go to any facility with a laboratory that can do WBC count (29.8%) or contact their usual endocrine clinic (24.4%). Nearly half of the patients (49%) were aware of the side effects of ATDs, but only 17 respondents (17.3%) identified one or both of the two most typical symptoms of agranulocytosis. The quality of the information received was evaluated as “not good at all” or “poor” by 19.2%. Over two-thirds (69.7%) of participants thought the amount of information was about right. Most participants (72.5%) preferred receiving information on side effects during consultations with their physicians. Since starting ATDs, 37.0% of patients have experienced different symptoms suggestive of agranulocytosis in various combinations. However, only one-third (12/37) had an urgent blood count. A review of 190 selected Arabic patient information Internet sites revealed a significant variation in patient advice. Six percent 11/190 (5.8%) of the sites can be considered good.

Conclusions The findings of suboptimal and inconsistent perceptions and practices of physicians and patients put patients with ATD in the Middle East at increased risk and call for more action from professional and patient advocacy groups.

Keywords

thyrotoxicosis antithyroid drugs - agranulocytosis - thionamides - physicians' practices - Internet - physicians' perceptions - questionnaire - survey

Authors' Contributions

SAB designed the study, managed the project, drafted the manuscript, and conducted the physicians' survey. All authors contributed substantially through patients' survey data collection, analysis, and review and approval of the final version of the manuscript. EA performed the Internet patients' information survey.

Compliance with Ethical Principles

The Sheikh Khalifa Medical City IRB approved study parts involving human subjects. All participants provided explicit informed consent to participate electronically (physicians) or verbally (patients) before participation in the surveys. All data are collected anonymously.

Publikationsverlauf

Artikel online veröffentlicht:
16. März 2023

• References

• 1 De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet 2016; 388 (10047): 906-918
• 2 Bartalena L, Piantanida E, Gallo D, Ippolito S, Tanda ML. Management of Graves' hyperthyroidism: present and future. Expert Rev Endocrinol Metab 2022; 17 (02) 153-166
• 3 Kravets I. Hyperthyroidism: diagnosis and treatment. Am Fam Physician 2016; 93 (05) 363-370
• 4 International Agranulocytosis and Aplastic Anaemia Study. Risk of agranulocytosis and aplastic anaemia in relation to use of antithyroid drugs. BMJ 1988; 297 (6643): 262-265
• 5 Meyer-Gessner M, Benker G, Lederbogen S, Olbricht T, Reinwein D. Antithyroid drug-induced agranulocytosis: clinical experience with ten patients treated at one institution and review of the literature. J Endocrinol Invest 1994; 17 (01) 29-36
• 6 Nakamura H, Miyauchi A, Miyawaki N, Imagawa J. Analysis of 754 cases of antithyroid drug-induced agranulocytosis over 30 years in Japan. J Clin Endocrinol Metab 2013; 98 (12) 4776-4783
• 7 Pearce SHS. Spontaneous reporting of adverse reactions to carbimazole and propylthiouracil in the UK. Clin Endocrinol (Oxf) 2004; 61 (05) 589-594
• 8 Ehrhart MD, Guthrie IR, Bucheli JR, Burge MR. What is the role of race and ethnicity in the development of thionamide-induced neutropenia?. J Endocrinol Thyroid Res 2018; 3 (01) 555601
• 9 Kaushal K, Bhattacharyya A, Gibson CM, Varghese B, Davis JR. Adequacy of information delivered to patients during consultation for thyrotoxicosis. Clin Endocrinol (Oxf) 2004; 61 (06) 778-779
• 10 Chong LPL, James LJ. Improving patient awareness of antithyroid medications. Endocr Abstracts 2010; 21: 71
• 11 Blonde L, Parkin CG. Internet resources to improve health care for patients with diabetes. Endocr Pract 2006; 12 (Suppl 1): 131-137
• 12 Joury AU, Alshathri M, Alkhunaizi M, Jaleesah N, Pines JM. Internet websites for chest pain symptoms demonstrate highly variable content and quality. Acad Emerg Med 2016; 23 (10) 1146-1152
• 13 Corcelles R, Daigle CR, Talamas HR, Brethauer SA, Schauer PR. Assessment of the quality of Internet information on sleeve gastrectomy. Surg Obes Relat Dis 2015; 11 (03) 539-544
• 14 Truumees D, Duncan A, Mayer EK, Geck M, Singh D, Truumees E. Cross sectional analysis of scoliosis-specific information on the internet: potential for patient confusion and misinformation. Spine Deform 2020; 8 (06) 1159-1167
• 15 Beshyah SA, Ali KF. Management of adrenal insufficiency: a survey of perceptions and practices of physicians from the Middle East and North Africa. J Diabetes Endocr Pract 2021; 4: 125-130
• 16 Beshyah SA, Khalil AB. Clinical practice patterns in the management of thyroid nodules: the first survey from the Middle East and Africa. J Diabetes Endocr Pract 2021; 4: 167-174
• 17 Beshyah SA, Almalki MH, Azzoug S, Barake M, Al Dahmani K, Chihaoui M. Diagnosis and management of Cushing's disease: a Survey of endocrinologists from the Middle East and North Africa. J Diabetes Endocr Pract 2022; 5: 21-28
• 18 Beshyah SA, Bashir M, Ekhzaimy A. et al. Practice patterns of diagnosis and management of polycystic ovary syndrome: a survey of physicians from the Middle East and Africa. J Diabetes Endocr Pract 2022; DOI: 10.1055/s-0042-1759643.
• 19 Beshyah SA, Sherif IH, Chentli F. et al. Management of prolactinomas: a survey of physicians from the Middle East and North Africa. Pituitary 2017; 20 (02) 231-240
• 20 Beshyah SA, Khalil AB, Sherif IH. et al. Clinical practice patterns in management of Graves' disease in the Middle East and North Africa. Endocr Pract 2017; 23 (03) 299-308
• 21 Robinson J, Richardson M, Hickey J. et al. Patient knowledge of antithyroid drug-induced agranulocytosis. Eur Thyroid J 2014; 3 (04) 245-251
• 22 Lynch MJ, Woodford NW. Fatality complicating agranulocytosis in the setting of carbimazole therapy. Forensic Sci Med Pathol 2008; 4 (04) 246-249