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Carbimazole-induced agranulocytosis — SCE Endocrinology MCQ

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HardThyroidCarbimazole-induced agranulocytosisSCE Endocrinology

A 30-year-old woman has thyrotoxicosis with goitre and mild orbitopathy. She develops fever and sore throat 6 weeks after starting carbimazole. Neutrophils are 0.2 x10^9/L; TSH is suppressed and free T4 remains high. What is the most appropriate management?

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Correct answer: A — Stop carbimazole, treat agranulocytosis urgently and use alternative thyrotoxicosis control

Stop carbimazole, treat agranulocytosis urgently and use alternative thyrotoxicosis control is best because carbimazole-associated agranulocytosis is an emergency requiring immediate drug cessation and infection management. The alternatives are less appropriate because dose reduction is unsafe; propylthiouracil may cross-react; radioiodine is not immediate sepsis management and may worsen orbitopathy; levothyroxine worsens thyrotoxicosis. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: BNF; NICE NG145