Therapeutic plasma exchange (TPE) is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis. We report a 35-yr-old man with thyrotoxicosis, ultimately attributed to Graves' disease in whom antithyroid drug used initially was soon discontinued, due to abnormal liver function, and replaced by Lugol's solution. Three weeks later, an escape phenomenon (to Lugol's solution) was apparent, so we performed TPE to control the thyrotoxicosis. Two courses of TPE by a centrifugal type machine resulted in diminished levels of thyroid hormone levels, which then rebounded after another two courses of membrane filtration type TPE. However, the patient could be treated with radioactive iodine therapy without any complications at present.
Adult ; Antithyroid Agents/adverse effects/therapeutic use ; Cetirizine/adverse effects/therapeutic use ; Graves Disease/*radiotherapy ; Hepatitis B, Chronic/complications ; Humans ; Iodides/therapeutic use ; Iodine Radioisotopes/*therapeutic use ; Male ; Methimazole/adverse effects/therapeutic use ; Plasmapheresis/*methods ; Thyroid Gland/*pathology ; Thyrotoxicosis/*therapy

Interferon-induced thyroiditis (IIT) is a major clinical problem for patients receiving interferon-alpha (IFN-alpha) therapy. But, destructive thyroiditis followed by Graves' disease associated with IFN-alpha therapy is very rarely reported. Herein, we report a rare case of pegylated IFN-alpha (pegIFN-alpha) induced destructive thyroiditis followed by Graves' disease in a patient with HCV infection. A 31-yr-old woman suffered from chronic active hepatitis C and was treated with pegIFN-alpha and ribavirin for 12 months. Results of a thyroid function test and autoantibody levels were normal before IFN-alpha therapy was initiated. Destructive thyrotoxicosis appeared seven months after the initiation of IFN-alpha therapy, followed by Graves' thyrotoxicosis two months after the cessation of therapy. The diagnoses of destructive thyroiditis and Graves' disease were confirmed by the presence of TSH receptor antibodies in addition to Tc-99m scintigraphy findings. The patient's antithyroglobulin antibody titer increased gradually during IFN-alpha therapy and remained weakly positive after IFN-alpha therapy was discontinued.
Adult ; Antiviral Agents/*adverse effects/therapeutic use ; Female ; Graves Disease/*chemically induced ; Hepatitis C, Chronic/*drug therapy ; Humans ; Interferon-alpha/*adverse effects/therapeutic use ; Methimazole/therapeutic use ; Propranolol/therapeutic use ; Thyroiditis/*chemically induced

OBJECTIVETo study the relationship between methimazole (MMI) and antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis.

METHODSThirty-three cases with Graves' disease were tested for serum ANCA before and after taking MMI. At the same time, clinicopathological data of two patients with Graves' disease who had antineutrophil cytoplasmic antibody-positive vasculitis during treatment with MMI were analyzed.

RESULTSTwo patients developed antineutrophil cytoplasmic antibody-positive vasculitis during the medication with MMI for 5-6 years; their major clinical manifestations were hematuria and renal failure. Renal biology showed renal vasculitis and vascular necrosis. The disease was relieved after treatment with immunosuppressor. Serum ANCA in the 33 cases was negative before taking MMI. In 3 cases serum ANCA became positive after taking MMI for 2 months, 3 months and 2 years, respectively. The positive rate is 9% (3/33). The major finding was microscopic hematuria. ANCA positive rate was significantly higher after taking MMI than that before taking MMI (chi2) = 5.3, P < 0.05). Microscopic hematuria disappeared after general treatment.

CONCLUSIONThere may be a relationship between methimazole and development of antineutrophil cytoplasmic antibody-positive vasculitis. Renal impairment can occur. The signs and symptoms of the vasculitis can disappear after proper treatment.

Adolescent ; Antibodies, Antineutrophil Cytoplasmic ; blood ; Antithyroid Agents ; adverse effects ; therapeutic use ; Child ; Female ; Graves Disease ; drug therapy ; pathology ; Humans ; Kidney ; pathology ; Male ; Methimazole ; adverse effects ; therapeutic use ; Vasculitis ; chemically induced

Both Graves disease and Guillain-Barre syndrome (GBS) are autoimmune disorders caused by impaired self-tolerance mechanisms and triggered by interactions between genetic and environmental factors. GBS in patients who suffer from other autoimmune diseases is rarely reported, and the development of postinfectious GBS in a patient with Graves disease has not been previously reported in the literature. Herein, we report a patient with Graves disease who developed postinfectious GBS during a course of methimazole-induced agranulocytosis.
Agranulocytosis/*chemically induced/diagnosis/therapy ; Antithyroid Agents/*adverse effects ; Female ; Graves Disease/diagnosis/*drug therapy ; Guillain-Barre Syndrome/diagnosis/*etiology/therapy ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Methimazole/*adverse effects ; Middle Aged ; Opportunistic Infections/diagnosis/*etiology/therapy ; Thyroidectomy ; Treatment Outcome

Adolescent ; Adult ; Aged ; Antithyroid Agents ; administration & dosage ; adverse effects ; therapeutic use ; Biomarkers ; blood ; Female ; Hepatitis B ; complications ; pathology ; Hepatitis, Viral, Human ; complications ; pathology ; Humans ; Hyperthyroidism ; complications ; drug therapy ; Liver Function Tests ; Male ; Methimazole ; administration & dosage ; adverse effects ; therapeutic use ; Middle Aged ; Propylthiouracil ; administration & dosage ; adverse effects ; therapeutic use ; Retrospective Studies ; Severity of Illness Index ; Thyroid Function Tests ; Young Adult

Bullous systemic lupus erythematosus (SLE) is a kind of LE-non-specific bullous skin disease that is rarely induced by a medication. We describe the first case of bullous SLE to develop after administration of methimazole. A 31-yr-old woman presented with generalized erythematous patches, multiple bullae, arthralgia, fever, conjunctivitis, and hemolytic anemia. Biopsy of her bulla showed linear deposition of lgG, lgA, C3, fibrinogen, and C1q at dermo-epidermal junction. She was diagnosed as bullous SLE and treated with prednisolone, dapsone, hydroxychloroquine, and methotrexate. Our experience suggests that SLE should be considered as a differential diagnosis when bullous skin lesions develop in patients being treated for hyperthyroidism.
Adult ; Anti-Inflammatory Agents/therapeutic use ; Antirheumatic Agents/therapeutic use ; Antithyroid Agents/*adverse effects/therapeutic use ; Blister/chemically induced/pathology ; Drug Therapy, Combination ; Female ; Graves Disease/diagnosis/drug therapy ; Humans ; Hydroxychloroquine/therapeutic use ; Immunosuppressive Agents/therapeutic use ; Lupus Erythematosus, Systemic/chemically induced/*diagnosis/drug therapy ; Lupus Nephritis/diagnosis/drug therapy ; Methimazole/*adverse effects/therapeutic use ; Mycophenolic Acid/analogs & derivatives/therapeutic use ; Prednisolone/therapeutic use ; Skin/pathology

OBJECTIVETo compare the therapeutic effect and side effect of the treatments on hyperthyroid exophthalmos with the combination of acupuncture and medication and with medication only.

METHODSFifty-two cases were randomly divided into an acupuncture and medication group (27 cases) and a medication group (25 cases). Acupuncture in combination of oral taking of Thiamazole and Euthyrox were adopted for the acupuncture and medication group. And acupoints such as Jingming (BL 1), Chengqi (ST 1) and Sizhukong (TE 23) etc. were selected. Western medication for oral taking was applied as the only treatment for the medication group. Objective eye syndrome marks, side effects and accidents were compared between two groups before and after treatment.

RESULTSThe improvement of the objective marks of eye syndrome in the acupuncture and medication group was better than that in the medication group (P < 0.01). There were 4 cases with hypoleucocytosis, 3 cases with rash and 3 cases with aggravated symptom of exophthalmos in the medication group during the treatment, while no case with side effects was observed in the acupuncture and medication group. However, 8 cases were found with hemorrhage and 8 with hematoma in the acupuncture and medication group.

CONCLUSIONTreatment with the combination of acupuncture and medication may not only enhance the therapeutic effect, but also reduce the side effects.

Acupuncture Points ; Acupuncture Therapy ; adverse effects ; Adult ; Combined Modality Therapy ; Drug-Related Side Effects and Adverse Reactions ; Exophthalmos ; Female ; Graves Ophthalmopathy ; drug therapy ; therapy ; Humans ; Male ; Methimazole ; adverse effects ; therapeutic use ; Middle Aged ; Thyroxine ; adverse effects ; therapeutic use ; Treatment Outcome ; Young Adult

Methimazole (MMI)-induced acute pancreatitis is very rare but severe adverse reaction. A 51-yr-old male developed a high fever, chills, and abdominal pain, two weeks after commencement on MMI for the treatment of Graves' disease. There was no evidence of agranulocytosis, and fever subsided soon after stopping MMI treatment. However, 5 hr after taking an additional dose of MMI, abdominal pain and fever developed again. His symptoms, biochemical, and imaging studies were compatible with acute pancreatitis. After withdrawal of MMI, he showed clinical improvement. This is the first case of MMI-induced acute pancreatitis in Korea. Clinicians should be aware of the rare but possible MMI-induced pancreatitis in patients complaining of fever and abdominal pain.
Abdominal Pain/*chemically induced/diagnosis ; Acute Disease ; Diagnosis, Differential ; Fever of Unknown Origin/*chemically induced/diagnosis ; Graves Disease/*drug therapy ; Humans ; Male ; Methimazole/*adverse effects/*therapeutic use ; Middle Aged ; Pancreatitis/*chemically induced/diagnosis ; Treatment Outcome

Methimazole (MMI)-induced acute pancreatitis is very rare but severe adverse reaction. A 51-yr-old male developed a high fever, chills, and abdominal pain, two weeks after commencement on MMI for the treatment of Graves' disease. There was no evidence of agranulocytosis, and fever subsided soon after stopping MMI treatment. However, 5 hr after taking an additional dose of MMI, abdominal pain and fever developed again. His symptoms, biochemical, and imaging studies were compatible with acute pancreatitis. After withdrawal of MMI, he showed clinical improvement. This is the first case of MMI-induced acute pancreatitis in Korea. Clinicians should be aware of the rare but possible MMI-induced pancreatitis in patients complaining of fever and abdominal pain.
Abdominal Pain/*chemically induced/diagnosis ; Acute Disease ; Diagnosis, Differential ; Fever of Unknown Origin/*chemically induced/diagnosis ; Graves Disease/*drug therapy ; Humans ; Male ; Methimazole/*adverse effects/*therapeutic use ; Middle Aged ; Pancreatitis/*chemically induced/diagnosis ; Treatment Outcome