Woeber Kenneth A
Department of Medicine, University of California, San Franscisco, California 94143-1640, USA.
Endocr Pract. 2002 May-Jun;8(3):222-4. doi: 10.4158/EP.8.3.222.
To present the case of a patient with Graves' hyperthyroidism in whom treatment with methimazole led to severe cholestasis.
A detailed case report and an overview of previously published cases of methimazole- and carbimazole-induced hepatotoxicity, found in a MEDLINE search with use of methimazole, carbimazole, thionamides and antithyroid agents as subject headings, are provided.
In a 36-year-old woman with severe hyperthyroidism, treatment with methimazole (20 mg twice daily) was initiated. Nineteen days later, pruritus, scleral icterus, dark urine, and abdominal discomfort prompted discontinuation of the therapy. Laboratory investigations and abdominal ultrasonography showed findings consistent with a cholestatic reaction to methimazole. Recovery was slow but complete. Of the 30 previously published cases of hepatotoxicity related to treatment with methimazole or carbimazole in which the nature of the hepatic injury was described, 19 were also cholestatic.
Physicians should be aware that thionamide drugs can be associated with hepatotoxicity. Analysis of the known cases suggests that older age of the patient and higher dose of the drug are risk factors for cholestatic injury.
报告1例格雷夫斯甲状腺功能亢进症患者使用甲巯咪唑治疗后发生严重胆汁淤积的病例。
提供一份详细的病例报告，并概述先前发表的使用甲巯咪唑和卡比马唑导致肝毒性的病例，这些病例是通过在MEDLINE数据库中以甲巯咪唑、卡比马唑、硫代酰胺类和抗甲状腺药物作为主题词检索获得的。
一名36岁重度甲状腺功能亢进症女性患者开始使用甲巯咪唑治疗（每日2次，每次20mg）。19天后，瘙痒、巩膜黄染、深色尿和腹部不适促使停药。实验室检查和腹部超声检查结果显示与甲巯咪唑引起的胆汁淤积反应一致。恢复过程缓慢但完全。在先前发表的30例与甲巯咪唑或卡比马唑治疗相关的肝毒性病例中，其中描述了肝损伤的性质，19例也是胆汁淤积性的。
医生应意识到硫代酰胺类药物可能与肝毒性有关。对已知病例的分析表明，患者年龄较大和药物剂量较高是胆汁淤积性损伤的危险因素。
