title: Intravenous methimazole in the treatment of refractory hyperthyroidism.
abstract: BACKGROUND
  Management of a hyperthyroid patient unable to take oral or rectal medication is a difficult clinical problem. The need for an alternative parenteral route of antithyroid medication administration in thyrotoxic patients occurs in certain rare cases, such as emergent gastrointestinal surgery, bowel ileus or obstruction, or severe vomiting and diarrhea. We report a simple and successful protocol for the preparation and use of intravenous methimazole (MMI) for treatment of hyperthyroidism in patients intolerant of orally and rectally administered thionamides.
  
  
  METHODS
  Five hundred milligrams of methimazole USP powder was reconstituted with pH-neutral 0.9% sodium chloride solution to a final volume of 50 mL using aseptic technique, then filtered through a 0.22-microm filter. MMI injection was administered as a slow intravenous push over 2 minutes and followed by a saline flush.
  
  
  METHODS
  A 76-year-old man, intolerant of oral and rectal medications because of an ileus and intractable diarrhea, who developed worsening thyrotoxicosis after an emergent spinal cord decompression, and a 42-year-old man with chronic liver disease and hyperthyroidism, requiring emergent exploratory laparotomy and maintenance of complete bowel rest because of persistent gastrointestinal bleeding were rendered euthyroid using intravenous MMI.
  
  
  CONCLUSIONS
  Two cases of hyperthyroidism successfully treated with a preparation of intravenous MMI are described.
authors.affiliation: Georgetown University Hospital, Division of Endocrinology and Metabolism, Washington, DC 20007, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Hodak
authors.forename: Caroline
authors.initials: C
authors.lastname: Huang
authors.forename: Donna
authors.initials: D
authors.lastname: Clarke
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Burman
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jonklaas
authors.forename: Natasa
authors.initials: N
authors.lastname: Janicic-Kharic
mesh_terms: D000328:Adult; D000368:Aged; D013956:Antithyroid Agents / Q000008:administration & dosage*; D004333:Drug Administration Routes; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy*; D007262:Infusions, Intravenous; D008297:Male; D008713:Methimazole / Q000008:administration & dosage*; D013961:Thyroid Gland / Q000473:pathology; D013997:Time Factors
chemical_list: D013956:Antithyroid Agents; D008713:Methimazole