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All Journal CRJIM (Clinical and Research Journal in Internal Medicine) Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD)
Laksmi Sasiarini
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Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Other

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Agranulocytosis Induced by Antithyroid Drug (Propiltyourasil): A Rare Case Ferdiana , Asihanti; Nyoman Satvika Dharma Yudha; Laksmi Sasiarini; Rulli Rosandi; Rinadhi Reza Bramantya
Clinical and Research Journal in Internal Medicine Vol. 6 No. 1 (2025): Volume 6 No 1, May 2025
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2025.006.01.15

Abstract

Antithyroid drugs can cause agranulocytosis in 0.2-0.5% of cases of Graves' disease, which can be life-threatening. Although rare, prompt management is crucial for a good outcome. A 41-year-old woman presented to the emergency department in March 2023 with complaints of fever, odynophagia, cough, nausea, vomiting, and weight loss. She had been diagnosed with hyperthyroidism in 2015 and was prescribed thiamazole 5mg once daily. She was declared cured in 2018. In February 2023, she was hospitalized for heart failure and diagnosed with Graves' disease. She was discharged with PTU 100mg three times daily. After two weeks of PTU treatment, the patient developed symptoms of agranulocytosis. Laboratory tests showed low white blood cell count and abnormal thyroid function. PTU therapy was discontinued, and the patient was treated with SC GCSF 300mg once daily, IV Ceftriaxone 1g twice daily, IV Ciprofloxacin 400mg twice daily, PO Propranolol 40mg three times daily with a target heart rate <90 beats per minute, and PO Thiamazole 5mg once daily initiation again because there is no side efect at previous medication with the same regiment and the alternative treatment such as iodine radioactive and surgery did not perform yet. Although initially the ANC was low, the patient's condition improved, and she was discharged after 13 days of treatment with normal laboratory results. Follow-up outpatient monitoring showed continued improvement. Accurate diagnosis and appropriate management are crucial in handling agranulocytosis induced by antithyroid drugs, which can significantly improve treatment outcomes and the patient's prognosis.
Clinical Inertia on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Study in Primary Healthcare Facilities Rinadhi Reza Bramantya; Laksmi Sasiarini; Rulli Rosandi
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
Publisher : PP PERKENI

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Abstract

The prevalence of type 2 diabetes mellitus (T2DM) in Indonesia continues to rise, with projections estimating 28.6 million cases by 2045. This increase poses significant health and economic burdens, especially due to complications resulting from poor glycemic control. This study aimed to evaluate the proportion of T2DM patients achieving optimal glycemic control (HbA1c ≤7%) and to identify factors related to clinical inertia in primary healthcare facilities in Malang, Indonesia. A cross-sectional study design was used, incorporating secondary data from 2256 PROLANIS patients' medical records (2020) and primary data from 580 questionnaires administered to doctors, healthcare providers, and patients. Only 32% of patients achieved HbA1c ≤7%, with higher levels of HbA1c observed among male patients and those with abnormal lipid profiles and microalbuminuria. Metformin alone was associated with the highest rate of glycemic control, while combination regimens such as metformin + sulfonylurea were linked to lower control. Logistic regression identified age, sex, lipid profile, and microalbuminuria as significant factors affecting glycemic control. From the provider side, good clinical practices were associated with adherence to guidelines, moderate workloads, and sufficient patient education. However, variability in guideline availability and lack of standardized protocols in Prolanis facilities posed barriers. Patient knowledge did not correlate significantly with treatment adherence, although most patients had moderate understanding of their condition. These findings underscore the need for standardized care guidelines and targeted interventions at the patient, provider, and system levels to improve glycemic outcomes and reduce diabetes-related complications in primary care settings.
Co-Authors Ferdiana , Asihanti Nyoman Satvika Dharma Yudha Rinadhi Reza Bramantya Rulli Rosandi