Endocrine Abstracts

Thyrotoxicosis is a common disorder especially in women. Most of the patients tolerate antithyroid medications very well with very few developing life threatening side effects. We describe a 64 years old gentleman who was diagnosed with hyperthyroidism secondary to Grave’s disease (autoimmune). He was treated with Carbimazole 20 mg daily. With in a month, he presented with malaise and reduced oral intake. Laboratory investigations showed acute cholestatic hepatitis with raised alkaline phosphatise (ALP) and alanine transaminase (ALT). His Carbimazole was stopped and was given beta blockers to control his symptoms. His serum Ceruloplasmin, autoimmune screen and iron studies were normal. His viral hepatitis screen for A, B and C was negative and ultrasound scan of his liver was normal The patient’s symptoms and laboratory abnormalities resolved with in ten days after withdrawing the offending drug and he was started on Propylthiouracil. His liver functions were normal three months after starting Propylthiouracil. Both Carbimazole and Propylthiouracil can cause liver dysfunction. But since the mechanism of liver damage is different, antithyroid medications can be interchanged without increasing the risk of further liver damage.