Endocrine Abstracts

A 20-year-old female patient with Graves’ disease was commenced on PTU 50 mg OD in June 2009 because of intolerance to carbimazole. She presented with jaundice within 5 months and was subsequently admitted when she started vomiting 2 months later.

She had tenderness in the right upper quadrant. LFT on admission are alkaline phosphatase 268 μ/l (35–104), gamma glutamyl transferase 148 μ/l (5–36), aspartame transferase 194 μ/l (5–38), Bilirubin 226–μ/l (1–17). Liver biopsy showed cirrhotic appearance with expansion of the portal tracts with bridging fibrosis. PTU was stopped; she had a total thyroidectomy and made a slow recovery.

Studies show that PTU- induced hepatotoxicity clinically present as elevations in serum transaminases, whereas other cases show a cholestatic picture with elevated bilirubin and alkaline phosphatases only. Transient increase in aminotransferases has been observed within the first week of treatment in up to 28% of patients.

Our poster aims to show links between published cases of PTU induced hepatotoxicity in adults, with unusually high or low liver enzymes values. The common trends in survival, recovery and death in patients with PTU induced hepatotoxicity. PTU-induced hepatitis is diagnosed based on the occurrence of liver damage within a few months of initiation of therapy; the study aims to show common aspects of microscopic pathology and to recommend frequent LFT testing in patients using PTU. It also aims to review the American Thyroid Association (ATA) guide lines for PTU use and show that mild elevated of liver enzymes during PTU therapy may be a sign of PTU hepatotoxicity.