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Acute pancreatitis and parotitis induced by methimazole in a patient with Graves' disease
M Taguchi1, M Yokota, H Koyano
1Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan.
Abstract:
A wide variety of adverse effects of methimazole (MMI) have been reported. Here we report a new MMI-induced disorder, acute pancreatitis and parotitis. Three weeks after a woman started MMI treatment for Graves' disease, she developed a high fever, painful parotid swelling and dull pain in the upper abdomen with elevation of the serum levels of salivary and pancreatic enzymes. These abnormalities disappeared soon after the withdrawal of MMI. However, the same abnormalities were rapidly provoked when MMI was reintroduced. Marked increases in the leucocyte count and CRP were also observed during these episodes. The possible mechanisms of MMI-induced pancreatitis/parotitis are discussed.
Insights
Methimazole (MMI) can cause rare side effects. This study details a new MMI-induced disorder involving acute pancreatitis and parotitis, highlighting potential risks of this Graves' disease treatment.
Area of Science:
- Endocrinology
- Pharmacology
- Gastroenterology
Background:
- Methimazole (MMI) is a common treatment for Graves' disease.
- While MMI is generally safe, various adverse effects have been documented.
- The full spectrum of MMI-induced toxicity requires ongoing investigation.
Observation:
- A patient developed acute pancreatitis and parotitis three weeks after initiating MMI.
- Symptoms included fever, painful parotid swelling, and upper abdominal pain with elevated pancreatic and salivary enzymes.
- These symptoms resolved upon MMI withdrawal and recurred upon reintroduction.
Findings:
- The study reports a novel association between methimazole and concurrent acute pancreatitis and parotitis.
- Elevated leukocyte count and C-reactive protein (CRP) were noted during symptomatic episodes.
- The findings suggest a direct causal link between MMI and the observed gastrointestinal and salivary gland inflammation.
Implications:
- Clinicians should consider pancreatitis and parotitis in patients presenting with relevant symptoms during MMI therapy.
- This case expands the known adverse effect profile of methimazole.
- Further research into the mechanisms of MMI-induced pancreatitis and parotitis is warranted.