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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2022; 05(04): 145-153
DOI: 10.1055/s-0043-1761438
Original Article

Physicians' and Patients' Perceptions and Practices Concerning Antithyroid Drug-Induced Agranulocytosis

Salem A. Beshyah
1   The Endocrine Clinic, Yas Clinic Khalifa City, Khalifa City, Abu Dhabi, UAE
2   Department of Medicine, Dubai Medical College, Dubai, UAE
3   Department of Medicine, College of Medicine and Health Sciences, Khalifa City, Abu Dhabi, UAE
,
Alaa Eldin Bashier 
4   Dubai Hospital, Dubai Health Authority, Dubai, UAE
,
Bachar Afandi
5   Department of Diabetes and Endocrinology, Tawam Hospital, Al Ain, UAE
6   Department of Medicine, College of Medicine and Health Sciences, UAEU, Al Ain, UAE
,
Mohammed Naman Mohammed
7   Department of Medicine, Fujairah General Hospital, Fujairah, UAE
,
Elamin Abdelgadir
4   Dubai Hospital, Dubai Health Authority, Dubai, UAE
,
Anas S. Beshyah 
8   Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
› Author Affiliations Funding None received.
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Abstract

Objectives We aimed to ascertain physicians' attitudes and practices and evaluate patients' knowledge of antithyroid drugs (ATDs). Also, we would like to review the quality of patients' information on the Internet (in Arabic) concerning ATDs' including agranulocytosis.

Methods A mixed methods study design was employed, including an online physician questionnaire, structured interviews of patients on ATDs, and evaluation on web sites containing patients' information in Arabic.

Results Most physicians (82.6%) thought the frequency of agranulocytosis in patients receiving antithyroid medications is 1 to 5 per 1,000 per annum. Nearly 72% of the participants reported educating their patients about the risk of agranulocytosis when they receive ATDs regularly verbally only. Most physicians thought patients should be warned about sore throat and fever. More participants would measure a white blood cell (WBC) count only if a patient developed suggestive symptoms (57.0%) than those who do it routinely (43.0%). If a patient receiving ATDs develops suspicious symptoms, participants thought that the most efficient way to deal with this is to attend the nearest hospital emergency department (37.2%). Less thought they can go to any facility with a laboratory that can do WBC count (29.8%) or contact their usual endocrine clinic (24.4%). Nearly half of the patients (49%) were aware of the side effects of ATDs, but only 17 respondents (17.3%) identified one or both of the two most typical symptoms of agranulocytosis. The quality of the information received was evaluated as “not good at all” or “poor” by 19.2%. Over two-thirds (69.7%) of participants thought the amount of information was about right. Most participants (72.5%) preferred receiving information on side effects during consultations with their physicians. Since starting ATDs, 37.0% of patients have experienced different symptoms suggestive of agranulocytosis in various combinations. However, only one-third (12/37) had an urgent blood count. A review of 190 selected Arabic patient information Internet sites revealed a significant variation in patient advice. Six percent 11/190 (5.8%) of the sites can be considered good.

Conclusions The findings of suboptimal and inconsistent perceptions and practices of physicians and patients put patients with ATD in the Middle East at increased risk and call for more action from professional and patient advocacy groups.

Keywords

thyrotoxicosis antithyroid drugs - agranulocytosis - thionamides - physicians' practices - Internet - physicians' perceptions - questionnaire - survey

Authors' Contributions

SAB designed the study, managed the project, drafted the manuscript, and conducted the physicians' survey. All authors contributed substantially through patients' survey data collection, analysis, and review and approval of the final version of the manuscript. EA performed the Internet patients' information survey.


Compliance with Ethical Principles

The Sheikh Khalifa Medical City IRB approved study parts involving human subjects. All participants provided explicit informed consent to participate electronically (physicians) or verbally (patients) before participation in the surveys. All data are collected anonymously.


Supplementary Material



Publication History

Article published online:
16 March 2023

© 2023. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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