methimazole and Jaundice

Topics: Alkaline Phosphatase; Aspirin; Chemical and Drug Induced Liver Injury; Cholestasis; Female; Halothane; Humans; Hyperbilirubinemia; Jaundice; Liver; Liver Diseases; Male; Methimazole; Paraquat; Transaminases

The objective of this work is to report our experience with (131)I therapy without recent antithyroid drug (ATD) pretreatment for refractory severe hyperthyroidism complicated by hyperbilirubinemia due to hepatic dysfunction.. Five patients with refractory severe hyperthyroidism were treated with (131)I at 90 to 120 μCi/g-thyroid (total activity, 6.2 to 10.1 mCi). The patients previously had received ATD treatment from 2 months to 12 years and discontinued ATDs from 2 months to 4 years before (131)I treatment due to treatment failure or severe jaundice. Prior to (131)I therapy, the patients were asked to take a low-iodine diet and were treated with bisoprolol fumarate, digoxin, furosemide, S-adenosylmethionine, polyene phosphatidylcholine, and plasma exchange as supportive treatment for related clinical conditions. Four of the patients also received lithium carbonate in conjunction with their (131)I treatment. The patients were followed for 4 to 9 years after (131)I therapy.. After (131)I treatment, jaundice disappeared completely within 3 to 4 months in all patients, and liver function tests returned to normal. Concurrent atrial fibrillation and heart failure, leukopenia and thrombocytopenia, or thrombocytopenia and left cardiac enlargement improved remarkably in 3 patients during the follow-up period. Three to 45 months after (131)I treatment, hypothyroidism was noted in the patients and they were treated with L-thyroxine replacement therapy.. (131)I therapy without recent ATD pretreatment for refractory severe hyperthyroidism complicated by serious jaundice appears to be safe and effective, with good long-term results. It may be the preferred therapy for such patients and should be used as early as possible.

Topics: Adult; Antithyroid Agents; Chemical and Drug Induced Liver Injury; China; Female; Humans; Hyperbilirubinemia; Hyperthyroidism; Iodine Radioisotopes; Jaundice; Liver Diseases; Male; Methimazole; Middle Aged; Propylthiouracil; Retrospective Studies; Severity of Illness Index

Jaundice related to thyrotoxicosis and not as an effect of antithyroid drugs is a rare complication that usually occurs in the presence of heart failure (HF) or hepatitis. We report a case of a 54-year-old white woman with hyperthyroidism caused by Graves's disease and jaundice despite methimazole suspension. Bilirubin fluctuated at high values, between 30.0 and 52.3 mg/dL, transaminases were slightly increased, on admission ALT = 46 U/L and AST = 87 U/L; coagulation indices and serum proteins were on the lower limit of the normal range with PT 68% and albumin = 2.5 g/dL. Serology for hepatitis was negative. After the first radioiodine therapy (RT), bilirubin reached its maximum, which coincided with the worst period of HF exacerbation. Bilirubin normalized 4 weeks after the second RT, with the stabilization of HF and normalization of thyroid hormones. We discuss the possible etiologies of severe jaundice in hyperthyroid patients, as well as the difficult anticoagulant therapy with warfarin.

Topics: Antithyroid Agents; Cardiomyopathies; Female; Heart Atria; Humans; Jaundice; Methimazole; Middle Aged; Severity of Illness Index; Thrombosis; Thyrotoxicosis

Topics: Agranulocytosis; Animals; Antibodies; Antigen-Antibody Complex; Antithyroid Agents; Basophils; Cytoplasm; Cytoplasmic Granules; Drug Eruptions; Eosinophilia; Eosinophils; Female; Guinea Pigs; Heart Failure; Humans; Hyperthyroidism; Imidazoles; Immunoassay; Jaundice; Leukocyte Count; Methimazole; Middle Aged; Neutrophils

Topics: Antithyroid Agents; Humans; Jaundice; Liver; Methimazole

Topics: Antithyroid Agents; Humans; Jaundice; Methimazole