Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

Abstract

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.

Carbimazole Drug-Induced Hepatitis during Treatment of Graves’ Disease: About Four Cases at Dakar Teaching Hospital

“…The average age of our patients was 43 years, with extreme ages of 32 and 54 years. This result is consistent with those of Akmal et al [8], which reported an age of onset of hepatotoxicity beyond 40 years. This adulthood is due to the occurrence of Graves' disease.…”

“…Biological assays have made it possible to specify the mixed character of this hepatitis, cholestatic and cytolytic, as reported by other authors [8] [11], all paraclinical examinations for differential diagnosis, most of which were very costly, especially viral serology, had not been possible for all patients because of our unfavorable socio-economic context. This fact constitutes a brake on the establishment of unfailing diagnosis of drug-induced hepatitis which remains a diagnosis of elimination.…”

“…The frequency of occurrence was esti-Open Journal of Internal Medicine mated between 0.1 and 0.2% [7]. Akmal and col. [8] regained a frequency of less than 0.5%. Doho Hiro [9] found 2 cases of cholestatic jaundice in 106 patients treated with carbimazole, a frequency of 1.88%.…”

“…Akmal and col [8] found a delay in the onset of carbimazole-induced liver disease, which ranged from a few days to five months. However, Burgin S. [13] reported a case with a delay of 18 months after initial carbimazole administration.…”

“…However, it can sometimes fail. The clinical picture of hepatotoxicity of carbimazole usually includes signs such as jaundice, pruritus, feeling of faintness and asthenia [8].…”