A Thorn in the Treatment of Graves’ Disease: The Hidden Allergen
https://doi.org/10.15605/jafes.041.S1
- Author:
Suprhamanyam Evali
1
;
Siew Huang Lee
2
;
Karen Christelle
3
;
Anilah Abdul Rahim
4
Author Information
1. Endocrinology Unit, Hospital Putrajaya
2. Pharmacy Department, Hospital Kuala Kangsar
3. Family Medicine, Klinik Kesihatan Felda Bersia
4. Endocrinology Department, Hospital Raja Permaisuri Bainun
- Publication Type:Journal Article
- MeSH:
Graves Disease;
Allergens
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):120-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Graves’ disease is typically managed with antithyroid
drugs (ATDs) and beta-blockers like propranolol. While
allergic reactions to ATDs are common, beta-blockers are
rarely identified as allergens.
Case:A 42-year-old female with Graves’ disease was started
on carbimazole 5 mg daily and propranolol 40 mg daily.
She developed mild itchiness, which was tolerable.
One month later, liver enzyme derangement led to the
discontinuation of carbimazole. Propylthiouracil (PTU)
300 mg daily was initiated while continuing propranolol,
but caused generalized urticaria, necessitating its cessation.
Prednisolone was started, but her thyroid function worsened.
Alternative therapies were proposed but declined by the
patient. Upon resolution of urticaria, PTU was reintroduced
at 50 mg daily without adverse effects, and propranolol
was discontinued. Her cutaneous symptoms did not recur,
implicating propranolol as the allergen.
Conclusion:In hyperthyroidism, increased hepatic clearance reduces
plasma propranolol levels, minimizing the risk of
adverse effects. However, as thyroid function normalizes,
propranolol clearance slows, leading to drug accumulation
and increased susceptibility to side effects. Clinicians
should consider all medications as potential allergens and
understand how thyroid states affect drug metabolism to
optimize treatment.
- Full text:202608050955085250EP_A180.pdf
