Propylthiouracil-Induced Acute Liver Failure: Role of Liver Transplantation

Abstract

Propylthiouracil- (PTU-) induced hepatotoxicity is rare but potentially lethal with a spectrum of liver injury ranging from asymptomatic elevation of transaminases to fulminant hepatic failure and death. We describe two cases of acute hepatic failure due to PTU that required liver transplantation. Differences in the clinical presentation, histological characteristics, and posttransplant management are described as well as alternative therapeutic options. Frequent monitoring for PTU-induced hepatic dysfunction is strongly advised because timely discontinuation of this drug and implementation of noninvasive therapeutic interventions may prevent progression to liver failure or even death.

Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

“…Various mechanisms have been proposed including inhibition of glucoronyl transferase, reduced bile acid synthesis and increased oxygen consumption by hepatocytes [5][6][7]. Liver biopsy and postmortem examinations have revealed various degrees of inflammation and liver necrosis.…”

“…Liver transplantation was required for some patients with fulminant hepatic failure [3][4][5]29]. One pregnant patient received a successful liver transplant but had fetal death [30].…”

A rare case of neomercazole induced hepatitis

“…15 While much less common, there have been rare case reports of acute hepatic failure and death from methimazole. 16 Patients who previously had neomercazole induced hepatitis should not be rechallenged as there is a high risk of recurrence.…”

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

“…11,13 On the other hand, clinicians advised frequent monitoring of liver function in PTU-treated patients. 11,13,17,[40][41][42][43][44] Hence, finding the mechanism(s) of PTU-induced hepatotoxicity might help to prevent or cure liver injury induced by this drug. Previously, we found that PTU-induced liver injury was associated with oxidative stress and its associated complications in the liver.…”

“…[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. 17 There is no precise mechanism for PTU-induced liver injury.…”