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Related Experiment Videos

Delayed cholestatic hepatitis due to methimazole.

Y T Hung1, W K Yu, E Chow

  • 1Department of Medicine, Our Lady of Maryknoll Hospital, Shatin Pass Road, Wongtaisin, Hong Kong.

Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi
|February 1, 2002
PubMed
Summary

Methimazole, used for thyrotoxicosis, can cause delayed and prolonged cholestatic hepatitis. This case highlights the importance of considering drug-induced liver injury in patients with unexplained jaundice.

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Area of Science:

  • Hepatology
  • Pharmacology
  • Internal Medicine

Background:

  • Cholestatic hepatitis is a liver inflammation characterized by impaired bile flow.
  • Drug-induced liver injury (DILI) is a significant cause of hepatitis, often presenting with diverse clinical manifestations.
  • Methimazole is an antithyroid medication commonly used to treat hyperthyroidism.

Purpose of the Study:

  • To report an unusual case of delayed and prolonged cholestatic hepatitis potentially induced by methimazole.
  • To emphasize the importance of considering methimazole as a causative agent in drug-induced liver injury.
  • To discuss the diagnostic challenges and clinical course of methimazole-induced cholestatic hepatitis.

Main Methods:

  • Case report of a 71-year-old male patient presenting with progressive cholestatic hepatitis.

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  • Diagnostic workup included viral hepatitis markers, ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP).
  • Liver biopsy was performed to evaluate the cause of hepatitis, and a temporal relationship with methimazole use was investigated.

    • Main Results:

    • The patient exhibited progressive cholestatic hepatitis with negative viral markers and normal biliary tree on imaging.
    • A history of methimazole treatment for thyrotoxicosis was noted a few weeks prior to jaundice onset.
    • Liver biopsy findings supported methimazole as the likely cause of the cholestatic hepatitis, which had a delayed onset and prolonged course.

    Conclusions:

    • Methimazole can cause delayed-onset and prolonged cholestatic hepatitis, representing an unusual presentation of drug-induced liver injury.
    • Physicians should maintain a high index of suspicion for DILI, including methimazole-induced hepatitis, in patients with unexplained cholestasis.
    • Early recognition and withdrawal of the offending drug are crucial for managing methimazole-induced cholestatic hepatitis.