title: Methimazole-induced cholestatic jaundice in an elderly hyperthyroid patient.
abstract: BACKGROUND
  Hyperthyroidism is a common disease in the elderly. Antithyroid medications such as methimazole are one of the few treatment options.
  
  
  METHODS
  A 76-year-old white woman presented to the clinic with a 1-week history of fatigue, sleepiness, 7-pound weight loss, and tachycardia. Her blood work showed low levels of thyroid-stimulating hormone and high levels of free thyroxine. Due to persistence of her symptoms, she was hospitalized and started on methimazole 10 mg TID. Six weeks after receiving methimazole for the treatment of hyperthyroidism, she had severe jaundice and itching. Results of her liver function tests showed elevation of her alkaline phosphatase and liver transaminase levels, as well as hyperbilirubinemia, formed mainly of the conjugated fraction. Methimazole-induced cholestatic jaundice was diagnosed. Her symptoms gradually improved after discontinuation of the medication, and plasma bilirubin levels were near normal after 8 weeks without methimazole.
  
  
  CONCLUSIONS
  We report here a probable association between methimazole use and severe cholestatic jaundice in an elderly hyperthyroid patient. The patient's jaundice was reversed after drug discontinuation.
authors.affiliation: Division of Geriatric Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA. lsrbmd@verizon.net
authors.forename: Luz S
authors.initials: LS
authors.lastname: Ramos-Bonner
authors.forename: Todd H
authors.initials: TH
authors.lastname: Goldberg
authors.forename: Susan
authors.initials: S
authors.lastname: Moyer
authors.forename: Catherine
authors.initials: C
authors.lastname: Anastasopoulou
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000187:drug effects / Q000378:metabolism; D000469:Alkaline Phosphatase / Q000187:drug effects / Q000378:metabolism; D013956:Antithyroid Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy; D041781:Jaundice, Obstructive / Q000139:chemically induced*; D008111:Liver Function Tests; D008713:Methimazole / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D013956:Antithyroid Agents; D008713:Methimazole; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin