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Hyperthyroidism symptom relief — GPhC CRA MCQ

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HardEndocrine TherapeuticsHyperthyroidism symptom reliefGPhC CRA

A patient started carbimazole three weeks ago and now reports fever, a severe sore throat and mouth ulcers. What is the most appropriate immediate advice?

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Correct answer: C — Stop carbimazole, seek urgent medical advice and obtain an immediate white-cell count

Fever, severe sore throat and mouth ulcers shortly after starting carbimazole may indicate neutropenia or agranulocytosis. The patient should stop carbimazole and seek medical advice immediately so that a white-cell count can be performed; treatment must not simply continue while awaiting a routine test. The reaction often occurs early and can be fatal. Propranolol is not the cause of carbimazole-associated marrow toxicity.

Reference: Carbimazole 5 mg tablets SmPC: https://www.medicines.org.uk/emc/product/14323/smpc