Cholestatic hepatitis due to methimazole
10.3760/cma.j.issn.1008-5734.2018.05.014
- VernacularTitle:甲巯咪唑致胆汁淤积型肝炎
- Author:
Ling YUAN
1
;
Wei SHEN
1
;
Shuang LI
1
;
Qing YANG
1
;
Deyin TONG
1
Author Information
1. 223800,江苏省宿迁市第一人民医院药学部
- Publication Type:Journal Article
- Keywords:
Methimazole;
Chemical and drug induced injury
- From:
Adverse Drug Reactions Journal
2018;20(5):382-384
- CountryChina
- Language:Chinese
-
Abstract:
A 32-year-old female patient with hyperthyroidism received methimazole 10 mg orally thrice daily.Three weeks later,she developed fatigue,anorexia,deep-colored urine,and pruritus of whole body skin.Methimazole was stopped.Laboratory tests showed the total bilirubin (TBil) of 463.1 μmol/L,bilirubin direct (DBil) of 348.9 μmol/L,alanine aminotransferase (ALT) of 142 U/L,aspartate aminotransferase (AST) of 64 U/L,and alkaline phosphatase (ALP) of 499 U/L.Cholestatic hepatitis induced by methimazole was considered.The patient received IV infusion of reduced glutathione,polyene phosphatidylcholine,hepatocyte growth-promoting factors,alprostadil,adenosylmethionine 1,4-butanedisulfonate,and methylprednisolone sodium succinate,and oral ursodeoxycholic acid capsules.Thirteen days later,the laboratory tests showed TBil of 432.3 μmol/L,DBil of 260.6 μmol/L,and total bile acid (TBA) of 564.0 μmol/L.The patient received 4 times of plasmapheresis within 8 days because her pruritus was not improved.On day 3 after the last plasmapheresis,laboratory tests showed TBil of 271.3 μmoL/L,DBil of 175.3 μmol/L,and TBA of 483.0 μmol/L.Liver-protective drugs and medications used to treat jaundice were continued.On day 47 after the last plasmapheresis,laboratory tests showed TBil of 22.4 μmol/L,DBil of 8.3 μmol/L,ALT of 35 U/L,AST of 20 U/L,ALP of 114 U/L,and TBA of 47.0 μmol/L.On day 51 after the last plasmapheresis,her pruritus and yellowish skin and sclera disappeared,her urine color returned to normal,and her physical strength recovered.
