Poster Session：PS 0193 ; Endocrinology : Carbimazole Induced Cholestatic Jaundice in Toxic Multinodular Goitre = Poster Session：PS 0193 ; Endocrinology : Carbimazole Induced Cholestatic Jaundice in Toxic Multinodular Goitre

다국어 초록 (Multilingual Abstract)

Antithyroid drugs are used to treat toxic multinodular goitre(TNG). Carbimazole is usually the drug of choice except in pregnancy where propylthiouracil is used. It is well tolerated and common side effects include allergy, upper GI upset, rarely agranulocytosis. Hepatitis is rare but serious complication.We report a 55yr female with TNG, who developed cholestatic hepatitis after carbimazole therapy for 2 months. She recovered completely following withdrawal of the drug.Toxic multinodular goitre (Plummer`s disease) is a 2nd most common cause for hyperthyroidism after Grave`s disease, 15-30% cases, (>50 years) and women. Unlike Grave`s disease which is autoimmune and antithyroids are started universally, TNG is not known to recur after therapy. So surgery or radioiodine are treatment of choice. Antithyroids are used for symptomatic relief in patients waiting surgery. Side effects are mild, include allergic reactions, upper GI intolerance, agranulocytosis, vasculitis-like reaction particularly propylthiouracil. Hepatotoxicity is rarebut serious side-effect with both carbimazole and propylthiouracil (PTU). Histology with PTU shows toxic hepatitis &necrosis and it is cholestatic hepatitis with carbimazole. Our case demonstrates carbimazole induced cholestatic hepatitis in patient with TNG. Clinical,biochemical fi nding with relevant review of literature is presented. Patient was put on propranolol, prednisolone in the interim for her thyrotoxicosis and exophthalmosis. Liver function tests improved signifi cantly following stoppage of carbimazole. The high degree of alkaline phosphatase could also be due to effect of hyperthyroidism on bone resorption. She is currently euthyroid. In summary, jaundice as a complication of thionamide treatment of hyperthyroidism is rare, this complication cannot be predicted by deranged liver enzymes at presentation, but typically occurs within three months of therapy, it can be fatal, particularly when there are additional hepatotoxic factors, and the drug must be withdrawn immediately and alternative therapy, such as radioiodine must be considered in appropriate patients.