Analysis of 90 cases of antithyroid drug-induced severe hepatotoxicity over 13 years in China.
BACKGROUND
Antithyroid drug (ATD)-induced severe hepatotoxicity is a rare but serious complication of ATD therapy. The characteristics of severe hepatotoxicity have been reported in only a small number of patients.


METHODS
Ninety patients with ATD-induced severe hepatotoxicity presenting during a 13 year period (2000-2013) who were about to undergo nuclear medicine therapy with (131)I from a sample of 8864 patients with hyperthyroidism were studied, and the outcomes were evaluated.


RESULTS
The mean age of the patients with ATD-induced severe hepatotoxicity was 41.6±12.5 years (mean±standard deviation), and the female to male ratio was 2.2:1. The methimazole (MMI) dose given at the onset was 19.1±7.4 mg/day. The propylthiouracil (PTU) dose given at the onset was 212.8±105.0 mg/day. ATD-induced severe hepatotoxicity occurred in 63.3%, 75.6%, and 81.1% of patients within 4, 8, and 12 weeks of the onset of ATD therapy, respectively. The types of severe hepatotoxicity did not differ significantly between the MMI and PTU groups (p=0.188). The frequency of the cholestatic type in the MMI group (35.3%, 18/51) was higher than that in the PTU group (17.9%, 7/39), but these frequencies were not significantly different (p=0.069). The patients who were treated with (131)I received an average dose of 279.1±86.1 MBq (n=84). Therapy was successful in 60 of the 67 patients (89.6%). The success rate was equivalent (p=0.696) between the groups receiving MMI (91.7%, 33/36) and PTU (87.1%, 27/31).


CONCLUSIONS
Severe hepatotoxicity tends to occur within the first three months after the onset of ATD therapy. The type of ATD-induced severe hepatotoxicity did not differ between the MMI and PTU groups. (131)I therapy is an effective treatment approach for patients with ATD-induced severe hepatotoxicity.
Department of Nuclear Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, P.R. China.
Jun
J
Yang
Lin-Fa
LF
Li
Qin
Q
Xu
Jun
J
Zhang
Wan-Wen
WW
Weng
Yang-Jun
YJ
Zhu
Meng-Jie
MJ
Dong
D000328:Adult; D000368:Aged; D013956:Antithyroid Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000188:drug therapy*; D008099:Liver / Q000187:drug effects*; D008297:Male; D008713:Methimazole / Q000009:adverse effects; D008875:Middle Aged; D011441:Propylthiouracil / Q000009:adverse effects; D012189:Retrospective Studies; D013974:Thyroxine / Q000097:blood; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000097:blood; D055815:Young Adult
D013956:Antithyroid Agents; D014284:Triiodothyronine; D008713:Methimazole; D011441:Propylthiouracil; D013974:Thyroxine