# Grave's, RIA & Diabetes



## lab31262 (Jul 6, 2010)

My 20 year old son was very recently diagnosed with Grave's Disease. After taking methimazole and propanolol for approximately 3 weeks he developed a rash and fever ranging from 100.5 to 103. A CBC showed his white cell count was only 2 and his ABS neutrophile count was only .24. He was just released from the hospital after a few days in reverse isolation, IV antibiotics and treatment with injections to increase his white cell count. The doctors said that due to the adverse reaction to the medication he will need RAI and he has been started on a low iodine diet in preparation. He is also a Type 1 diabetic on an insulin pump. Does anyone know what we can expect from his treatment and if there are any additional concerns due to his diabetes. I was also wondering how common of a side effect the reduced white cell count was for patients taking antithyroid medications.

Any information would be greatly appreciated.
Thanks!


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## chopper (Mar 4, 2007)

Here's some good info and a link to the full article from thyroid.org:

Heres the full article for reference:

http://www.thyroid.org/patients/patient_brochures/hyperthyroidism.html

Antithyroid drugs 
Drugs known as antithyroid agents-methimazole (Tapazole®) or propylthiouracil (PTU)-may be prescribed if your doctor chooses to treat the hyperthyroidism by blocking the thyroid gland's ability to make new thyroid hormone. These drugs work well to control the overactive thyroid, bring prompt control of hyperthyroidism, and do not cause permanent damage to the thyroid gland. In about 20% to 30% of patients with Graves' disease, treatment with antithyroid drugs for a period of 12 to 18 months will result in prolonged remission of the disease. For patients with toxic nodular or multinodular goiter, antithyroid drugs are used in preparation for either radioiodine treatment or surgery. Antithyroid drugs cause allergic reactions in about 5% of patients who take them. Common minor reactions are red skin rashes, hives, and occasionally fever and joint pains. A rarer (occurring in 1 of 500 patients), but more serious side effect is a decrease in the number of white blood cells. Such a decrease can lower your resistance to infection. Very rarely, these white blood cells disappear completely, producing a condition known as agranulocytosis, a potentially fatal problem if a serious infection occurs. If you are taking one of these drugs and get an infection such as a fever or sore throat, you should stop the drug immediately and have a white blood cell count that day. Even if the drug has lowered your white blood cell count, the count will return to normal if the drug is stopped immediately. But if you continue to take one of these drugs in spite of a low white blood cell count, there is a risk of a more serious, even life-threatening infection. Liver damage is another very rare side effect. You should stop the drug and call your doctor if you develop yellow eyes, dark urine, severe fatigue, or abdominal pain.

Source: thyroid.org
http://www.thyroid.org/patients/patient_brochures/hyperthyroidism.html


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## CA-Lynn (Apr 29, 2010)

I'm really sorry for your son's recent problems. While I really don't have solid answers for you, I think I might be able to point you to a few links where you might be able to get some good input. You see, I am a Type 2 diabetic and have several autoimmune diseases. I know how exasperating it can be trying to get everything under control.

I think I might be going against the rules of this forum by referring you to a Type 1 Diabetes forum, so I will be PM'ing the URL of that forum to you. Diabetes is a serious disease and it will be to your advantage to post your questions on that website. You can expect to get some good input by diabetics. Also, be sure to use the search feature and enter the common terms for related threads.

For reference, normal WBC range at my lab is 3.80 - 10.80. As I understand it, as long as there are no recurrent infections, the low WBC should not be worrisome. I will also be PM'ing a link to another website that addresses many of the questions you have raised.

http://en.allexperts.com/q/Pathology-1640/2008/1/diabetes-low-thyroid-low.htm

I'm not sure if you were referring to the percentage or actual manual differentiation when addressing the neutrophil count. In any case, your son's value of 2 is very low. Typically decreased neutrophils most commonly suggest aplastic anemia or drug-induced neutropenia [common with anti-thyroid drugs], folate or B-12 deficiency. 
Here's a link for Type 1 diabetes which addresses Graves, etc.

http://en.wikipedia.org/wiki/Diabetes_mellitus_type_1

It should be known that Diabetes Type 1 and concurrent thyroid disease are not altogether uncommon.

http://jcem.endojournals.org/cgi/content/abstract/82/1/143

You mentioned your son is Type 1 diabetic; out of curiosity has he ever been tested for Type 1.5 [autoimmune version]? It just seems that more and more those of us who have one autoimmune disease ultimately find we have antibodies for others.

Good luck. Be sure to check your Personal Message for a message from me with those links.

Lynn


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## Andros (Aug 26, 2009)

lab31262 said:


> My 20 year old son was very recently diagnosed with Grave's Disease. After taking methimazole and propanolol for approximately 3 weeks he developed a rash and fever ranging from 100.5 to 103. A CBC showed his white cell count was only 2 and his ABS neutrophile count was only .24. He was just released from the hospital after a few days in reverse isolation, IV antibiotics and treatment with injections to increase his white cell count. The doctors said that due to the adverse reaction to the medication he will need RAI and he has been started on a low iodine diet in preparation. He is also a Type 1 diabetic on an insulin pump. Does anyone know what we can expect from his treatment and if there are any additional concerns due to his diabetes. I was also wondering how common of a side effect the reduced white cell count was for patients taking antithyroid medications.
> 
> Any information would be greatly appreciated.
> Thanks!


This does happen from taking anti-thyroid meds. I don't know what the percentage rate might be but it is often enough for us to be cognizant of it and I believe it is even in the insert on adverse reactions.

Thank goodness I am not diabetic so I cannot really relate but I will say that we have several here who are and they manage very well. Not easy, lots of hard work but they do do it.


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## CA-Lynn (Apr 29, 2010)

Andros wrote: "....I will say that we have several here who are and they manage very well. Not easy, lots of hard work but they do do it."

It's all about being in control and knowledgeable about your body and your diseases. It's every human's responsibility! You only get one life so better make the best of it!


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## lab31262 (Jul 6, 2010)

I just wanted to thank everyone for their thoughtful replies. It is very much appreciated.


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