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Methimazole-induced cholestatic jaundice
1Division of Endocrinology, Department of Medicine, Olive View UCLA Medical Center, Sylmar, CA 91342-1495, USA. nasser.mikhail@gte.net
Southern Medical Journal
|February 26, 2004
Summary
Methimazole, an antithyroid drug, can rarely cause severe cholestatic jaundice. Promptly discontinuing methimazole therapy is crucial for symptom resolution and avoiding invasive procedures.
Area of Science:
- Endocrinology
- Hepatology
- Pharmacology
Background:
- Methimazole is a common antithyroid medication for hyperthyroidism.
- It is generally well-tolerated, but adverse effects can occur.
Observation:
- A 43-year-old woman developed severe jaundice, itching, and hyperbilirubinemia after 1 month of methimazole and propranolol treatment.
- Symptoms persisted for 2 weeks after initial presentation, with conjugated hyperbilirubinemia.
Findings:
- Methimazole-induced cholestasis was diagnosed as the cause of the patient's symptoms.
- Discontinuation of methimazole led to symptom improvement within 9 days.
- Plasma bilirubin levels normalized after 12 weeks off methimazole.
Implications:
- Methimazole can cause rare but severe, reversible cholestatic jaundice.
- Awareness of this adverse effect is vital for physicians and patients.
- Early discontinuation of methimazole can prevent complications and unnecessary interventions.