Successful Treatment of Hyperthyroidism with Amiodarone in a Patient with Propylthiouracil-Induced Acute Hepatic Failure

Abstract

Acute hepatic failure is a rare and potentially lethal complication of propylthiouracil (PTU) use for hyperthyroidism. We present a 20-year-old woman with Basedow-Graves' disease who developed PTU-induced fulminant hepatitis, which progressed to acute hepatic failure with grade III hepatic encephalopathy. Laboratory evaluation ruled out the most common causes of fulminant hepatitis. We treated her hyperthyroidism with amiodarone (average daily dose, 200 mg) for 3 weeks, achieving rapid and persistent euthyroidism, (triiodothyronine [T(3)] levels ranged between 64 and 109 ng/dL) without side effects. Amiodarone treatment did not abolish the thyroid radioactive iodine uptake (RAIU), allowing for subsequent treatment with radioactive iodine. The clinical course was favorable and the patient achieved full hepatic recovery 3 months after the hepatic failure was detected. After an extensive review of the literature, we believe that this is the first communication of the successful use of amiodarone to control hyperthyroidism in a patient with PTU-induced fulminant hepatitis.

Review article: the use of potentially hepatotoxic drugs in patients with liver disease

“…We are aware of a case report describing the safe use of amiodarone to treat hyperthyroidism in a patient who suffered PTU‐induced acute hepatic failure. This patient eventually underwent successful radioactive iodine treatment and liver function tests normalized 165 …”