Liver failure due to antithyroid drugs: report of a case and literature review

Abstract

Hyperthyroidism is a common endocrine disorder affecting 2% of females and 0.5% of males worldwide and antithyroid drugs constitute the first line of treatment in the majority of cases. These agents may cause severe adverse effects and among them liver failure, although rare, is a potential lethal one. This case illustrates the sudden and abrupt deterioration of hepatic function due to antithyroid drug administration. This case along with a concise literature review is presented aiming to increase the awareness of endocrinologists of possible fatal complications from the everyday use of common agents such as antithyroid drugs.

Sudden Onset Agranulocytosis and Hepatotoxicity after Taking Methimazole

“…The characteristics of her liver damage were similar to allergy-related hepatitis, with a significant elevation in transaminase instead of bilirubin and onset abruptly after the exposure to MMI. Fortunately, her liver dysfunction was mild to moderate, not severe compared with the cases reported to date (22,23,25), and the hepatotoxicity improved dramatically after MMI was suspended and hepatoprotective treatment was administered. All of the information discussed above indicate that the acute immune response may be the cross pathogenesis of agranulocytosis and hepatotoxicity for this case.…”

“…Fulminant liver function failure associated with thioamides can be fatal in 25-50% of cases (21). PTU-induced liver dysfunction is more common than MMI-induced liver dysfunction (22). MMI-associated hepatic abnormalities are typical of cholestatic process (23).…”

Toxicological considerations for antithyroid drugs in children

“…Of major concern, 27 liver transplants (16 in adults and 7 in children) and nine deaths in adults and three deaths in children were reported in the US following PTU administration during the last 18 years. Based on the above data and more recent reports [91], experts on the field strongly recommended to no more prescribing PTU in the pediatric population [92][93][94][95].…”

Propylthiouracil-induced mitochondrial dysfunction in liver and its relevance to drug-induced hepatotoxicity

“…6,7 PTU also causes serious adverse effects such as agranulocytosis and liver failure. [8][9][10] Several cases of PTU-induced hepatotoxicity have been reported. 4,[11][12][13][14][15][16] Pediatrics seems to be more vulnerable to PTU-induced hepatotoxicity.…”