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Methimazole-induced cholestatic jaundice.

Nasser E Mikhail1

  • 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
PubMed
Summary

Methimazole, an antithyroid drug, can rarely cause severe cholestatic jaundice. Promptly discontinuing methimazole therapy is crucial for symptom resolution and avoiding invasive procedures.

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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.

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