April - June 2014, Volume 10, Issue 2

Iliescu L, Toma L, Minzala G, Orban C

Acute Hepatitis after Methimazole. Case Report

Acta Endo (Buc) 2014, 10 (2): 267-272
doi: 10.4183/aeb.2014.267

Background. There are few cases of methimazole induced hepatitis. The mechanism is probably related to the fact that it is a hepatic- metabolised drug. Objective. To demonstrate the fact that an acute cholestatic hepatitis can be triggered by methimazole. Design. While dealing with a major cholestatic syndrome with cytolysis, we performed the following steps: correct and complete history, serum detection of acute viral hepatitis, an autoimmune cause and finally liver biopsy. Subjects and Methods. We present the case of an 80 year old woman, with a history of hyperthyroidism, in treatment with Methimazole. After a month, the patient developed jaundice, for which she was admitted to our clinic. On admission she presented an important cholestatic syndrome, with elevated transaminases (5 times normal). Results. None of the laboratory tests indicated a possible viral infection or autoimmune disease. Abdominal ultrasound revealed no possible obstruction of the biliary system. Ultimately we performed a liver biopsy, which revealed inflammatory infiltration and cholestasis. Conclusion. We conclude that the hepatitis was induced by methimazole. Corticotherapy was initiated, with a relatively slow but favourable evolution. I131- Radiation therapy was elected for the treatment of hyperthyroidism.

Keywords: Acute hepatitis, Methimazole.

Correspondence: Laura Iliescu MD, Fundeni Clinical Institute, Internal Medicine, Sos Fundeni nr. 258, sector 2, Bucharest, Romania, Bucharest, 022328, Romania, E-mail: laura_ate@yahoo.com