Gallelli Luca, Staltari Orietta, Palleria Caterina, De Sarro Giovambattista, Ferraro Maria
Clinical Pharmacology Unit, Chair of Pharmacology, Department of Experimental and Clinical Medicine, School of Medicine and Surgery, University Magna Graecia of Catanzaro, Mater Domini University Hospital, Via T. Campanella 115, 88100 Catanzaro, Italy.
Curr Drug Saf. 2009 Sep;4(3):204-6. doi: 10.2174/157488609789006912. Epub 2009 Sep 1.
We report a case of hepatotoxicity induced by methimazole treatment in a patient affected by hyperthyroidism. A 54-year-old man, presented to our observation for palpitations, excessive sweating, weakness, heat intolerance and weight loss. On physical examination, his blood pressure was 140/90 mmHg and heart beat was 100/min regular. He had mild tremors and left exophthalmos. Laboratory test revealed a significant increase in serum thyroid hormone levels with a decrease in thyroid stimulating hormone levels. A diagnosis of hyperthyroidism was made and he began treatment with methimazole (30 mg/day). Fourteen days later, he returned for the development of scleral icterus, followed by dark urine, and abdominal pain in the right upper quadrant. Laboratory examinations and liver biopsy performed a diagnosis of cholestatic hepatitis, secondary to methimazole usage. Methimazole was promptly withdrawn and cholestyramine, ursodeoxycholic acid, and chlorpheniramine were given. After five days, abdominal pain resolved and laboratory parameters returned to normal. Naranjo probability scale indicated a probable relationship between hepatotoxicity and methimazole therapy. In conclusion physicians should be aware the risk of hepatotoxicity related with methimazole.
我们报告了一例因甲巯咪唑治疗引起肝毒性的甲状腺功能亢进患者。一名54岁男性因心悸、多汗、乏力、不耐热和体重减轻前来就诊。体格检查时，他的血压为140/90 mmHg，心率为100次/分钟，规律。他有轻度震颤和左眼突眼。实验室检查显示血清甲状腺激素水平显著升高，促甲状腺激素水平降低。诊断为甲状腺功能亢进，他开始接受甲巯咪唑治疗（30毫克/天）。十四天后，他因出现巩膜黄疸、随后出现深色尿以及右上腹疼痛而复诊。实验室检查和肝活检诊断为胆汁淤积性肝炎，继发于甲巯咪唑的使用。甲巯咪唑立即停用，并给予消胆胺、熊去氧胆酸和氯苯那敏。五天后，腹痛缓解，实验室指标恢复正常。Naranjo概率量表表明肝毒性与甲巯咪唑治疗之间可能存在关联。总之，医生应意识到与甲巯咪唑相关的肝毒性风险。
