A Case of Methimazole-Induced Acute Hepatic Failure in A Patient with Chronic Hepatitis B Carrier

Abstract

We report a case of methimazole-induced acute hepatic failure, which occurred 17 weeks after initiation of the drug in a 43-year-old man with hyperthyroidism and hepatitis B surface antigenemia. Postmortem needle autopsy of the liver revealed an established micronodular cirrhosis secondary to hepatitis B with moderate septal/portal inflammation, marked cholestasis and scattered acidophilic bodies. The serum hepatitis B surface antigen (HBsAg) was positive, but reactivation of hepatitis B was unlikely in view of the absence of a serum hepatitis B e antigen (HBeAg) and hepatitis B virus deoxyribonucleic acid (HBV-DNA) and negative stain for HBsAg and hepatitis B core antigen (HBcAg) in the liver tissue.

Dissimilar Hepatotoxicity Profiles of Propylthiouracil and Methimazole in Children

“…Methimazole-related cholestasis is associated with high doses and older age (25). There is one case report of methimazolerelated liver failure leading to death in a 43-yr-old man with hyperthyroidism and hepatitis B (28). The death of a 20-yr-old woman treated with 90 mg/d methimazole for 8 months has been reported (29).…”

Acute-on-chronic liver failure due to thiamazole in a patient with hyperthyroidism and trilogy of Fallot: case report

“…However, there is, up till now, only one case reporting MMI-related acute liver failure in a patient with hyperthyroidism and chronic hepatitis B [9]. Symptom-onset of this adverse effect ranges from 3 days to 5 months following the initiation of MMI therapy [4].…”

Propylthiouracil (PTU) Hepatoxicity in Children and Recommendations for Discontinuation of Use

“…MMI-related cholestasis is associated with high doses and older age [51]. There is one case report of MMI-related liver failure leading to death in a 43-year-old man with hyperthyroidism and hepatitis B [54]. The death of a 20-year-old woman treated with 90 mg/day of methimazole for eight months has been reported [26].…”