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Fulminant hepatic failure associated with propylthiouracil.
Jorge K Ruiz1, Giorgio V Rossi, Humberto A Vallejos
1Department of Medicine, Hospital Carlos Van Buren, Valparaiso, Chile.
The Annals of Pharmacotherapy
|January 29, 2003
Summary
Propylthiouracil (PTU) can cause fatal liver failure in hyperthyroidism patients. Two women developed severe liver dysfunction and died despite treatment, highlighting rare but serious PTU hepatotoxicity risks.
Area of Science:
- Hepatology
- Endocrinology
- Pharmacology
Background:
- Propylthiouracil (PTU) is a common antithyroid drug used to manage hyperthyroidism, particularly Graves' disease.
- While generally safe, PTU has been associated with various adverse effects, including liver injury.
Observation:
- Two women without prior liver disease developed jaundice after 4-5 months of PTU treatment for Graves' disease.
- Their condition rapidly progressed to severe liver dysfunction, multisystem organ failure, and death, mimicking viral hepatitis.
- Autopsy revealed submassive hepatic necrosis; other causes of liver failure were excluded.
Findings:
- The Naranjo probability scale confirmed a probable link between PTU and the adverse hepatic events.
- These cases represent rare instances of fulminant hepatic failure directly attributable to PTU.
- A literature review identified eight prior deaths associated with PTU up to December 2000.
Implications:
- Clinicians should be vigilant for signs of severe hepatotoxicity in patients treated with PTU.
- This study adds to the documented cases of fatal PTU-induced liver injury, emphasizing the need for careful patient monitoring.
- Understanding these rare but severe risks is crucial for informed hyperthyroidism management.