Management of methimazole allergy with methimazole: about two cases

Oumeyma Trimeche; Amor Bilel Ben; Ekram Hajji; Ines Bayar; Sana Abid; Hela Marmouch; Hanene Sayadi; Ines Khochteli

doi:10.1530/endoabs.99.EP364

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Endocrine Abstracts (2024) 99 EP364 | DOI: 10.1530/endoabs.99.EP364

ECE2024 Eposter Presentations Thyroid (198 abstracts)

Management of methimazole allergy with methimazole: about two cases

Oumeyma Trimeche ¹ , Bilel Ben Amor ¹ , Ekram Hajji ¹ , Ines Bayar ¹ , Sana Abid ¹ , Héla Marmouch ¹ , Hanene Sayadi ¹ & Inès Khochteli ¹

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¹Fattouma Bourguiba University hospital, Monastir, Tunisia

Introduction: Graves’ disease is a frequent endocrine disorder, often treated as first-line therapy with antithyroid drugs. Herin, we report two female patients with Methimazole allergy while detailing its management.

Case Reports: TWO female patients aged respectively 27 and 28 years old were diagnosed with Graves’ disease (GD), diagnosed given the association of peripheral hyperthyroidism and elevated anti TSH receptor antibodies. The first developed a generalized dermographism urticaria one week after being put on 10 mg per day of methimazole (MTZ). After being ceased, she was put on 16 mg of Methyprednisone, 25 mg of Hydroxyzine and 10 mg of Cetirizine and careful restart of low dose MTZ. The lesions disappeared after two days and MTZ dose was progressively increased, to an optimal dose of 1 mg per day. Control thyroxine level was normal. The second developed urticaria shortly after MTZ introduction. Thus, she was put on Benzythiouracile (BZT), which was complicated with severe neutropenia. BZT was stopped. A first trial of low dose methimazole, Cetirizine and cholestyramine was carried out but failed since she redeveloped diffuse urticaria. MTZ was ceased and then carefully reintroduced at a dose of 2.5 mg per day associated with Cetirizine, Hydroxyzine and 0.5 mg per kg of prednisone. A significant improvement of her clinical symptomatology was noted few days later. Prednisone was tapered down and parallelly MTZ dose was increased to 40 mg per day. The two patients are actually euthyroid with MTZ and after three months of therapy corticoids were stopped. The first had thyroidectomy and is actually on optimal dose of Levothyroxine and the second had radioactive iodine therapy and was lost to follow up thereafter.

Conclusion: These cases highlight the possible treatment of methimazole allergy with corticoids and anti-histamine drugs and their reintroduction thereafter, while detailing the used protocol.