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Methimazole-Induced Cholestatic Jaundice: A Rare Case and Literature Review
Ahmed Mohamed Nefzi1, Dhouha Cherif1, Habiba Dabbebi1
1Gastroenterology B Department, La Rabta Hospital, Tunis, Tunisia.
Abstract:
Methimazole is commonly prescribed for patients with hyperthyroidism. It typically exhibits a well-tolerated profile, with common side effects including gastrointestinal disorders and rash. However, more serious rare yet adverse reactions, notably agranulocytosis and hepatotoxicity have been documented in literature. Here we present a case of a 27-year-old female, recently diagnosed with Graves' disease, who was prescribed methimazole and developed severe pruritus with cholestatic jaundice 13 days later. Concomitant causes of liver disease were ruled out. The treatment was discontinued, and a switch to corticosteroid therapy with a regimen of radioactive iodine sessions was initiated. The patient's condition showed a resolution of pruritus and jaundice, a disappearance of cytolysis with an aggravation of cholestasis followed by a gradual decrease, leading to the liver function normalization after 2 years. Methimazole-induced cholestatic jaundice is a rare yet severe adverse effect. Patients should be aware of this complication and advised to immediately stop taking the treatment when suggestive symptoms (pruritus, jaundice, dark urine, light-colored stool) occur.
Insights
Methimazole, used for hyperthyroidism, can rarely cause severe cholestatic jaundice. Patients experiencing symptoms like jaundice or itching should stop the medication immediately.
Area of Science:
- Endocrinology
- Hepatology
- Pharmacology
Background:
- Methimazole is a common treatment for hyperthyroidism.
- While generally safe, rare adverse effects like agranulocytosis and hepatotoxicity are known.
- Cholestatic jaundice is a severe but infrequent complication.
Purpose of the Study:
- To report a case of methimazole-induced cholestatic jaundice.
- To highlight the importance of recognizing this rare adverse effect.
Main Methods:
- Case presentation of a 27-year-old female with Graves' disease.
- Clinical observation of symptoms, laboratory tests, and treatment response.
- Exclusion of other causes of liver disease.
Main Results:
- The patient developed severe pruritus and cholestatic jaundice 13 days after starting methimazole.
- Discontinuation of methimazole and initiation of corticosteroid and radioactive iodine therapy led to symptom resolution.
- Liver function normalized over two years, with initial cholestasis aggravation followed by gradual decrease.
Conclusions:
- Methimazole can induce rare but severe cholestatic jaundice.
- Early recognition and discontinuation of methimazole are crucial for patient management.
- Patients should be educated about potential symptoms like pruritus and jaundice.
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