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Simultaneous treatment with carbimazole and granulocyte-colony stimulating factor in a patient with thyrotoxicosis and carbimazole induced neutropenia

100%

Talapatra I., Nagareddy V., Bhavnani M., Tymms D.

Open Medicine

2006

vol. 1

issue 4

419-423

We describe a patient who was admitted with uncontrolled thyrotoxicosis and carbimazole induced neutropenia. She required 80 mg of carbimazole daily. The patient declined radio-iodine treatment because she had a little child and wished to have thyroid surgery. She received four doses of filgrastim (Granulocyte-colony stimulating factor) which maintained the neutrophil count within a reasonable level while she continued to receive carbimazole to prepare her for surgery. After a curative subtotal thyroidectomy and discontinuation of the carbimazole, the patient’s white cell count remained normal. Subsequently the patient was euthyroid on levothyroxine replacement. Carbimazole should always be discontinued if neutropenia occurs but this case demonstrates that in exceptional circumstances filgrastim can be an effective therapy while continuing carbimazole in the short term.

Successful discontinuation of insulin treatment after gestational diabetes is shown to be a case of MODY due to a glucokinase mutation

88%

Talapatra I., Kalavalapalli S., Robinson J., Ellard S., Tymms D.

Open Medicine

2008

vol. 3

issue 2

225-228

We describe a woman who first presented with gestational diabetes at 26 weeks gestation and was managed with insulin. Following delivery of a healthy baby she had an abnormal OGTT (oral glucose tolerance test) 6 weeks post partum and was managed with diet. In her second pregnancy she was diagnosed with gestational diabetes at 10 weeks and required insulin. Following delivery she was again managed on diet alone. Four years later, during her third pregnancy, she was managed with insulin from the outset. She remained on insulin post partum and for several years. Later her two younger children, aged 11 years and 7 years, were found to have GCK mutation causing MODY (Maturity Onset Diabetes Of the Young) subtype glucokinase. Following this she underwent molecular genetic testing and was also shown to have the GCK mutation. She was gradually taken off insulin and is now managed on diet alone with excellent glycaemic control. Her two children are under regular follow up care and on no medication for diabetes.

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2 Open Medicine

1 2008

1 2006

2 Talapatra I.

2 Tymms D.

1 Bhavnani M.

1 Ellard S.

1 Kalavalapalli S.

1 Nagareddy V.

1 Robinson J.

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Simultaneous treatment with carbimazole and granulocyte-colony stimulating factor in a patient with thyrotoxicosis and carbimazole induced neutropenia

Successful discontinuation of insulin treatment after gestational diabetes is shown to be a case of MODY due to a glucokinase mutation