Acute Liver Failure Associated with Propylthiouracil in a Pregnant 26-Year-Old Woman

Miyamura, Tatsuo; Minemura, Shoko; Nakamura, Masato; Nakamoto, Shingo; Jiang, Xia; Wu, Shuang; Yasui, Shin; Arai, Makoto; Yokosuka, Osamu

doi:10.1159/000351877

Cited by 12 publications

(12 citation statements)

References 18 publications

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“…The eosinophilic infiltrates are indicative of drug or autoimmune reactions [3]. Case reports with liver biopsies done during the course of liver failure where viral etiologies and other secondary causes were ruled out have demonstrated centrolobular necrosis and ceroid granules consistent with drug-related injury [9].…”

Section: Mechanismmentioning

confidence: 99%

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Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

Akmal

Kung²

2014

Expert Opinion on Drug Safety

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PTU is known to cause severe hepatic failure, particularly in children. Its use in children should be avoided. In adults, it is beneficial to use in the first trimester of pregnancy and thyroid storm. In the rest of the adult population, it should be used with caution. Carbimazole and MMI are associated with less severe hepatic injury and should be preferred when choosing thionamides as a treatment option.

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Section: Mechanismmentioning

confidence: 99%

“…Patients with continued mild elevation over a few weeks can go into liver failure without preceding transaminases trending upward [9].…”

Section: Clinical Presentationmentioning

confidence: 99%

Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

Akmal

Kung²

2014

Expert Opinion on Drug Safety

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“…It has been indicated that children appeared to be at higher risk for PTU-induced liver injury than adults 1,10. Although PTU has been recommended to women with hyperthyroidism during their first trimester of pregnancy,1 the FDA has described two pregnant women who experienced adverse effects of PTU treatment,14 and another case report described a 26-year-old woman with PTU-associated ALF during her first trimester of pregnancy 15. Treatment with MMI, which is also frequently prescribed for patients with hyperthyroidism, can induce cholestatic hepatitis after drug exposure ranging from 2 days to 3 months 9…”

Section: Discussionmentioning

confidence: 99%

Propylthiouracil-induced liver failure and artificial liver support systems: a case report and review of the literature

Wu¹,

Chen²,

Bai³

et al. 2017

TCRM

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BackgroundAntithyroid drugs carry a potential risk of hepatotoxicity. Propylthiouracil (PTU) is commonly prescribed for patients with hyperthyroidism. PTU, however, can induce liver injury, ranging from mild asymptomatic elevation of aminotransferases to acute liver failure (ALF).Case presentationThis case reports on a 16-year-old Chinese girl with hyperthyroidism, who was admitted to our hospital for jaundice, nausea, and fatigue associated with severe hyperbilirubinemia and coagulopathy. She had been prescribed PTU 5 months earlier. There was no history of hypersensitivity to drugs, viral liver diseases, blood transfusion, or surgery. On the basis of her symptoms and the clinical data, she was diagnosed with PTU-induced ALF. Due to the limited number of available donor organs for liver transplantation, she was started on treatment with artificial liver support system (ALSS). After four sessions of ALSS, her clinical signs and symptoms were found to be markedly improved, and she was discharged 25 days after admission. Four months later, her liver function normalized.ConclusionAlthough PTU-induced liver failure is rare in clinical practice, liver function should be appropriately monitored during treatment with PTU. PTU-induced ALF in this patient was successfully managed with an ALSS, suggesting that the latter may be an alternative to liver transplantation.

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“…Propiltiouracilo: en una mujer con 10-14 semanas de embarazo se reportó edema, ictericia, pru rito y rash (40)(41)(42). El manejo dado a las pacientes fue la suspensión del medicamento y el tratamiento de los síntomas con farmacoterapia (40)(41)(42)(43)(44).…”

Section: Antitiroideosunclassified

“…El manejo dado a las pacientes fue la suspensión del medicamento y el tratamiento de los síntomas con farmacoterapia (40)(41)(42)(43)(44). La toxicidad hepática fue de tipo idiosincrásica, con consecuencias como insuficiencia hepática, trasplante hepático, muerte materna y neonatal (42,(45)(46)(47).…”

Section: Antitiroideosunclassified

Medicamentos causantes de hepatotoxicidad en el embarazo: revisión estructurada

Amariles

2017

Rev. Colomb. Gastroenterol.

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Objetivo: identificar los medicamentos y determinar las principales características asociadas con hepatotoxicidad por medicamentos en el embarazo.Método: revisión estructurada en PubMed/Medline, EMBASE y Web of Science utilizando los términos: Drug induced liver injury OR Hepatotoxicity AND Pregnancy. La búsqueda incluyó artículos en inglés, español, humanos, entre 2005 y 2015, con información sobre hepatotoxicidad por medicamentos en el embarazo. Fueron excluidos los artículos sin relación con embarazo o hepatotoxicidad, asociados con otras causas de enfermedad hepática o con hepatotoxicidad por otras sustancias. La información del medicamento y las características de los pacientes fueron registradas en una tabla. La probabilidad de la aparición de hepatotoxicidad fue valorada y agrupada en tres categorías: definida, probable y posible; para algunos medicamentos fue determinada por el método RUCAM.Resultados: fueron identificados 488 artículos, de los cuales 46 fueron seleccionados. Fueron identificados también 12 medicamentos (acetaminofeno, alfametildopa, labetalol, metotrexato, saquinavir, nevirapina, propiltiouracilo, metimazol, carbimazol, nitrofurantoína, ácido acetilsalicílico y piperidolato) con probabilidad de causar hepatotoxicidad en el embarazo. Algunas características asociadas con los fármacos fueron: tiempo de aparición de las reacciones, semanas de embarazo (3-36), factores de riesgo (edad y enfermedades crónicas), manifestaciones clínicas (elevación de transaminasas, prurito, ictericia) y desenlaces (trasplante de hígado, muertes materna y fetal).Conclusión: los medicamentos acetaminofeno, alfametildopa, labetalol, metotrexato, saquinavir, nevirapina, propiltiouracilo, metimazol, carbimazol, nitrofurantoína, ácido acetilsalicílico y piperidolato podrían causar hepatotoxicidad en pacientes embarazadas. Además de la dosis y del tiempo de exposición al fármaco, la edad y el tiempo de gestación podrían influir en la presentación y gravedad de la hepatotoxicidad.

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Acute Liver Failure Associated with Propylthiouracil in a Pregnant 26-Year-Old Woman

Cited by 12 publications

References 18 publications

Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

Propylthiouracil-induced liver failure and artificial liver support systems: a case report and review of the literature

Medicamentos causantes de hepatotoxicidad en el embarazo: revisión estructurada

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