1
|
Khan AA, Ata F, Aziz A, Elamin H, Shahzad A, Yousaf Z, Donato A. Clinical Characteristics and Outcomes of Patients With Antithyroid Drug-Related Liver Injury. J Endocr Soc 2023; 8:bvad133. [PMID: 38178906 PMCID: PMC10765380 DOI: 10.1210/jendso/bvad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Indexed: 01/06/2024] Open
Abstract
Context Antithyroid drugs (ATDs) are the cornerstone of hyperthyroidism management. Hepatotoxicity due to ATDs can range from mild transaminase elevation to liver transplantation requirement and mortality. Objective The primary objective of the systematic review was to assess the clinical characteristics and outcomes of patients with drug induced liver injury (DILI) due to ATDs. Methods We conducted a systematic review of PUBMED, SCOPUS, and EMBASE on characteristics and outcomes of adults (>18 years) with DILI due to ATDs. We defined DILI as bilirubin ≥2.5 mg/dL or international normalized ratio >1.5 with any rise in alanine aminotransferase (ALT), aminotransferase (AST), or alkaline phosphatase (ALP), or an elevation of ALT or AST >5 times or ALP >2 times the upper limit of normal without jaundice/coagulopathy. Results The review included 100 articles describing 271 patients; 148 (70.8%) were female (N = 209). Mean age was 42.9 ± 17.2 years. Graves' disease was the most common indication for ATDs. Carbimazole/methimazole (CBM/MMI) was the most common offending agent (55.7%). DILI pattern was hepatocellular in 41.8%, cholestatic in 41.3%, and mixed in 16.9%. Outcomes included death in 11.8%, liver transplantation in 6.4%, partial improvement in 2.2%, and complete resolution in 79.6% with a median time (IQR) to resolution of 45 (20-90) days. Patients in the propylthiouracil (PTU) group had higher initial bilirubin, initial AST, initial ALT, peak ALT, peak AST, severe and fatal DILI, liver transplantation, and mortality than CBM/MMI. Rechallenge of antithyroid medication was infrequently reported (n = 16) but was successful in 75%. Conclusion DILI due to ATDs can present with different patterns and should prompt immediate drug discontinuation. Referral to a hepatologist should be considered if severe as transplantation is sometimes required. PTU-induced DILI may have worse outcomes than CBM/MMI.
Collapse
Affiliation(s)
- Adeel Ahmad Khan
- Department of Endocrinology, Hamad Medical Corporation, 3050, Doha, Qatar
| | - Fateen Ata
- Department of Endocrinology, Hamad Medical Corporation, 3050, Doha, Qatar
| | - Afia Aziz
- Department of Internal Medicine, Hamad Medical Corporation, 3050, Doha, Qatar
| | - Hana Elamin
- National University-Sudan, Khartoum 11115, Sudan
| | - Aamir Shahzad
- Department of Medicine, Tower Health, West Reading, PA 19611, USA
| | - Zohaib Yousaf
- Department of Medicine, Tower Health, West Reading, PA 19611, USA
| | - Anthony Donato
- Department of Medicine, Tower Health, West Reading, PA 19611, USA
| |
Collapse
|
2
|
Kamath P, Kamath A, Ullal SD. Liver injury associated with drug intake during pregnancy. World J Hepatol 2021; 13:747-762. [PMID: 34367496 PMCID: PMC8326163 DOI: 10.4254/wjh.v13.i7.747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Drug use during pregnancy is not common. Drug-induced liver injury (DILI) is a potential complication that is rare but can adversely affect both the mother and the fetus. Although many drugs can directly cause hepatotoxicity, idiosyncratic liver injury is common in pregnancy. Underreporting of adverse drug reactions, lack of adequate literature regarding drug safety in pregnancy, and the inherent difficulty in diagnosing DILI during pregnancy make the management of this condition challenging. This review attempts to describe the existing literature regarding DILI in pregnancy, which is mainly in the form of case reports; several studies have looked at the safety of antithyroid drugs, antiretroviral drugs, and paracetamol, which have an indication for use in pregnancy; the relevant data from these studies with regard to DILI has been presented. In addition, the review describes the diagnosis of DILI, grading the disease severity, assessment of causality linking the drug to the adverse event, regulatory guidelines for evaluating the potential of drugs to cause liver injury, efforts to ensure better participation of women in clinical trials and studies in pregnant women population in particular, and the challenges involved in generating adequate research evidence. The establishment of DILI registries in various countries is an encouraging development; however, there is a need for promoting active, spontaneous reporting of adverse events during pregnancy to ensure rapid generation of evidence regarding the safety of a drug in pregnant women.
Collapse
Affiliation(s)
- Priyanka Kamath
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India - 575001
| | - Ashwin Kamath
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India - 575001
| | - Sheetal D Ullal
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India - 575001
| |
Collapse
|
3
|
Macular Rash, Thrombocytopenia, and Hyperbilirubinemia in a Preterm Infant. Case Rep Pediatr 2019; 2019:4076740. [PMID: 31093405 PMCID: PMC6476038 DOI: 10.1155/2019/4076740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/26/2019] [Indexed: 11/25/2022] Open
Abstract
Neonatal hyperthyroidism is usually caused by the passage of maternal thyroid receptor antibodies. This relatively rare condition has various manifestations including cholestasis, prematurity, and cardiomegaly. We present a case of a preterm infant with neonatal Graves' disease who presented with cholestasis, cardiomegaly, and a macularpapular rash that was thought to be suspicious for congenital infection. This case has been reported to illustrate lessons learnt for early identification of a neonate with Graves' disease in order to expedite treatment.
Collapse
|
4
|
Ba JH, Wu BQ, Wang YH, Shi YF. Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure: A case report. World J Clin Cases 2019; 7:500-507. [PMID: 30842962 PMCID: PMC6397818 DOI: 10.12998/wjcc.v7.i4.500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/21/2018] [Accepted: 12/30/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis, characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases, such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.
CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting, diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure. Moreover, she also suffered from heart failure. Therapeutic plasma exchange (commonly known as TPE) and continuous renal replacement therapy (commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.
CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.
Collapse
Affiliation(s)
- Jun-Hui Ba
- Department of Medical Intensive Unit, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Ben-Quan Wu
- Department of Medical Intensive Unit, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Yan-Hong Wang
- Department of Medical Intensive Unit, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Yun-Feng Shi
- Department of Medical Intensive Unit, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| |
Collapse
|
5
|
Jamshidzadeh A, Niknahad H, Heidari R, Azadbakht M, Khodaei F, Arabnezhad MR, Farshad O. Propylthiouracil-induced mitochondrial dysfunction in liver and its relevance to drug-induced hepatotoxicity. PHARMACEUTICAL SCIENCES 2017. [DOI: 10.15171/ps.2017.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
6
|
Wu DB, Chen EQ, Bai L, Tang H. Propylthiouracil-induced liver failure and artificial liver support systems: a case report and review of the literature. Ther Clin Risk Manag 2017; 13:65-68. [PMID: 28138249 PMCID: PMC5238756 DOI: 10.2147/tcrm.s122611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Antithyroid drugs carry a potential risk of hepatotoxicity. Propylthiouracil (PTU) is commonly prescribed for patients with hyperthyroidism. PTU, however, can induce liver injury, ranging from mild asymptomatic elevation of aminotransferases to acute liver failure (ALF). CASE PRESENTATION This case reports on a 16-year-old Chinese girl with hyperthyroidism, who was admitted to our hospital for jaundice, nausea, and fatigue associated with severe hyperbilirubinemia and coagulopathy. She had been prescribed PTU 5 months earlier. There was no history of hypersensitivity to drugs, viral liver diseases, blood transfusion, or surgery. On the basis of her symptoms and the clinical data, she was diagnosed with PTU-induced ALF. Due to the limited number of available donor organs for liver transplantation, she was started on treatment with artificial liver support system (ALSS). After four sessions of ALSS, her clinical signs and symptoms were found to be markedly improved, and she was discharged 25 days after admission. Four months later, her liver function normalized. CONCLUSION Although PTU-induced liver failure is rare in clinical practice, liver function should be appropriately monitored during treatment with PTU. PTU-induced ALF in this patient was successfully managed with an ALSS, suggesting that the latter may be an alternative to liver transplantation.
Collapse
Affiliation(s)
- Dong-Bo Wu
- Center of Infectious Diseases, West China Hospital of Sichuan University; Division of Molecular Biology of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, People's Republic of China
| | - En-Qiang Chen
- Center of Infectious Diseases, West China Hospital of Sichuan University; Division of Molecular Biology of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, People's Republic of China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University; Division of Molecular Biology of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, People's Republic of China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University; Division of Molecular Biology of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, People's Republic of China
| |
Collapse
|
7
|
Niknahad H, Jamshidzadeh A, Heidari R, Abdoli N, Ommati MM, Jafari F, Zarei M, Asadi B. The Postulated Hepatotoxic Metabolite of Methimazole Causes Mitochondrial Dysfunction and Energy Metabolism Disturbances in Liver. PHARMACEUTICAL SCIENCES 2016. [DOI: 10.15171/ps.2016.35] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
8
|
Chou C, Wong RJ, Higgins JP, Perumpail RB, Ahmed A. Acute Liver Failure: A Potential Complication of Antithyroid Medication Use. Dig Dis Sci 2015; 60:1924-7. [PMID: 25366145 DOI: 10.1007/s10620-014-3389-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/07/2014] [Indexed: 12/09/2022]
Affiliation(s)
- Christina Chou
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA,
| | | | | | | | | |
Collapse
|
9
|
Eser M, Basyigit S, Eser M, Nazligul Y. Propylthiouracil-related Toxic Hepatitis: Impact of Silent Cases. Euroasian J Hepatogastroenterol 2015; 5:134-135. [PMID: 29201711 PMCID: PMC5578545 DOI: 10.5005/jp-journals-10018-1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/25/2015] [Indexed: 11/23/2022] Open
Abstract
Liver is the main organ which can metabolize many drugs or chemical agents. Toxic events developed by drugs are one of the most common causes of liver damage. Toxic hepatitis can be encountered in different clinical situations, such as acute hepatitis, fulminant hepatitis chronic hepatitis or cirrhosis. We aimed to report a case of asymptomatic toxic hepatitis in a patient taking propylthiouracil (PTU). A 38 years old female patient admitted to hospital complained of fatigue. She had no special medical history except Graves' disease. She had been taking PTU 300 mg/day for 1 month. She had no history of another medication, eating mushroom, alcohol consumption, traveling, family history of liver disease. Her physical examination was normal. Laboratory analysis revealed that alanine aminotransferase-543 U/L, aspartate aminotransferase-227 U/L, gamma glutamyl transferase-66 U/L and alkaline phosphatase-136 U/L. Serum levels of bilirubin and albumin, INR, complete blood count and thyroid function tests were all normal. She had normal liver function test (LFT) before using PTU. Propylthiouracil was discontinued and she was given methimazole. She was examined for the etiology of abnormal LFT, but no specific etiology could be recorded. She was thought to have toxic hepatitis related to PTU. In her follow-up LFT has turned to normal level (Table 1). How to cite this article Eser M, Basyigit S, Eser M, Nazligul Y. Propylthiouracil-related Toxic Hepatitis: Impact of Silent Cases. Euroasian J Hepato-Gastroenterol 2015;5(2):134-135.
Collapse
Affiliation(s)
- Murat Eser
- Department of Internal Medicine, Kecioren Research and Training Hospital, Ankara, Turkey
| | - Sebahat Basyigit
- Department of Gastroenterology, Kecioren Research and Training Hospital, Ankara, Turkey
| | - Mithat Eser
- Department of Internal Medicine, Gulhane Millitary Medical Academy, Etlik, Turkey
| | - Yasar Nazligul
- Department of Gastroenterology, Kecioren Research and Training Hospital, Ankara, Turkey
| |
Collapse
|
10
|
Zhang R, Tian X, Qin L, Wei X, Wang J, Shen J. Factors predicting abnormal liver function tests induced by Graves' disease alone: a retrospective cohort study. Medicine (Baltimore) 2015; 94:e839. [PMID: 25984670 PMCID: PMC4602566 DOI: 10.1097/md.0000000000000839] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Abnormal liver function tests (LFTs) are often observed in patients with Graves' disease (GD). To date, there are limited data demonstrating the factors or biochemical indexes contributing to LFT abnormalities in this patient population. The aim of this study was to explore factors predicting abnormal LFTs induced by GD alone. This was a retrospective study of 289 consecutive cases of newly diagnosed and untreated patients with GD. All patients were divided into abnormal LFTs (group A) and normal LFTs (group B). In total, 205 (70.9%) cases were found to have at least 1 LFT abnormality. Among them, the frequencies of ALT, AST, ALP, γ-GTP, TBIL and DBIL abnormalities were 52.7%, 32.2%, 45.9%, 38.5%, 23.4%, 2.9%, respectively, and the number of patients with 1 to 6 hepatic variable abnormalities were 89, 64, 30, 16, 6 and 0, respectively. Logistic regression analysis was used to determine predictive factors contributing to abnormal LFTs. A receiver operating characteristic (ROC) curve was also plotted to verify the accuracy of predictors. In the univariate analysis, patients in group A had significantly higher FT3 concentration (37.5 vs 33.4 pmol/L, P = 0.009), FT4 concentration (85.7 vs 77.4 pmol/L, P = 0.002) and TRAb level (22.2 vs 17.4 IU/L, P < 0.001) when compared with those in group B. Binary logistic regression analysis identified higher FT4 concentration (odds ratio [OR]: 1.017, 95% confidence interval [CI]: 1.005-1.030, P = 0.006) and higher TRAb value (OR: 1.038, 95% CI:1.013-1.064, P = 0.003) to be independent risk factors predicting abnormal LFTs. The optimal cutoffs for FT4 and TRAb to predict abnormal LFTs were 75 pmol/L and 15 IU/L, respectively, based on ROC analysis.
Collapse
Affiliation(s)
- Ruiguo Zhang
- From the Department of Nuclear Medicine, Tianjin First Central Hospital (RGZ, LQ, JQW, JS); Department of Pathology, Research Institute of Liver Diseases, Tianjin Second People's Hospital, Tianjin (XT); and Department of Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China (XEW)
| | | | | | | | | | | |
Collapse
|
11
|
Francés Artigas C, Nicolau Ramis J, Rivera Irigoín R, González Moreno J, Masmiquel Comas L. [Dissociated cholestasis: an uncommon complication of thioamide therapy]. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2013; 60:340-342. [PMID: 23036935 DOI: 10.1016/j.endonu.2012.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 06/01/2012] [Accepted: 06/01/2012] [Indexed: 06/01/2023]
|
12
|
Almeida RFD, Comarella AP, Silveira MB, Silva ARBD, Casini AF. Plasmaférese pré-tireoidectomia em paciente com tireotoxicose e hepatotoxicidade por propiltiouracil: relato de caso. ACTA ACUST UNITED AC 2013; 57:322-6. [DOI: 10.1590/s0004-27302013000400008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/16/2013] [Indexed: 11/21/2022]
Abstract
A tireotoxicose é uma rara síndrome clínica decorrente da exacerbação do hipertireoidismo, de etiologia e fatores desencadeantes diversos. A abordagem terapêutica pode ser realizada por meio de medicamentos para bloqueio da síntese, secreção e/ou inibição da ação periférica hormonal, além de terapia dirigida aos fatores desencadeantes. Entretanto, em casos refratários, a plasmaférese surge como importante opção de tratamento. Relatamos o caso de um paciente com doença de Graves, internado com quadro de hepatotoxicidade grave por propiltiouracil, que evoluiu com tireotoxicose, sendo indicada plasmaférese para rápida redução dos hormônios tireoidianos, em preparo para a tireoidectomia total.
Collapse
|
13
|
Miyamura T, Kanda T, Minemura S, Nakamura M, Nakamoto S, Jiang X, Wu S, Yasui S, Arai M, Yokosuka O. Acute liver failure associated with propylthiouracil in a pregnant 26-year-old woman. Case Rep Gastroenterol 2013; 7:240-4. [PMID: 23798915 PMCID: PMC3678146 DOI: 10.1159/000351877] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
It seems appropriate to use propylthiouracil to treat maternal hyperthyroidism during the first trimester of pregnancy. We present the case of a 26-year-old woman with acute liver failure associated with propylthiouracil during the first trimester of pregnancy. She was successfully treated without liver transplantation. Attention should be paid to the possible occurrence of propylthiouracil-induced hepatotoxicity even during the first trimester of pregnancy.
Collapse
Affiliation(s)
- Tatsuo Miyamura
- Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Heidari R, Babaei H, Eghbal MA. Cytoprotective Effects of Organosulfur Compounds against Methimazole Induced Toxicity in Isolated Rat Hepatocytes. Adv Pharm Bull 2013; 3:135-42. [PMID: 24312826 DOI: 10.5681/apb.2013.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 11/14/2012] [Accepted: 11/15/2012] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Methimazole is a drug widely used in hyperthyroidism. However, life threatening hepatotoxicity has been associated with its clinical use. No protective agent has been found to be effective against methimazole induced hepatotoxicity yet. Hence, the capacity of organosulfur compounds to protect rat hepatocytes against cytotoxic effects of methimazole and its proposed toxic metabolite, N-methylthiourea was evaluated. METHODS Hepatocytes were prepared by the method of collagenase enzyme perfusion via portal vein. Cells were treated with different concentrations of methimazole, N methylthiourea, and organosulfur chemicals. Cell death, protein carbonylation, reactive oxygen species formation, lipid peroxidation, and mitochondrial depolarization were assessed as toxicity markers and the role of organosulfurs administration on them was investigated. RESULTS Methimazole caused a decrease in cellular glutathione content, mitochondrial membrane potential (ΔΨm) collapse, and protein carbonylation. In addition, an increase in reactive oxygen species (ROS) formation and lipid peroxidation was observed. Treating hepatocytes with N methylthiourea caused a reduction in hepatocytes glutathione reservoirs and an elevation in carbonylated proteins, but no significant ROS formation, lipid peroxidation, or mitochondrial depolarization was observed. N-acetyl cysteine, allylmercaptan, and diallyldisulfide attenuated cell death and prevented ROS formation and lipid peroxidation caused by methimazole. Furthermore, organosulfur compounds diminished methimazole induced mitochondrial damage and reduced the carbonylated proteins. In addition, these chemicals showed protective effects against cell death and protein carbonylation induced by methimazole metabolite. CONCLUSION Organosulfur chemicals extend their protective effects against methimazole-induced toxicity by attenuating oxidative stress caused by this drug and preventing the adverse effects of methimazole and/or its metabolite (s) on subcellular components such as mitochondria.
Collapse
Affiliation(s)
- Reza Heidari
- Faculty of Pharmacy, Pharmacology and toxicology department, Tabriz university of Medical Sciences, Tabriz, Iran. ; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ; Faculty of Pharmacy, Pharmacology and toxicology department, Tabriz university of Medical Sciences, Tabriz, Iran
| | | | | |
Collapse
|
15
|
Heidari R, Babaei H, Eghbal M. Mechanisms of methimazole cytotoxicity in isolated rat hepatocytes. Drug Chem Toxicol 2012; 36:403-11. [DOI: 10.3109/01480545.2012.749272] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
16
|
Heidari R, Babaei H, Eghbal MA. Ameliorative effects of taurine against methimazole-induced cytotoxicity in isolated rat hepatocytes. Sci Pharm 2012; 80:987-99. [PMID: 23264945 PMCID: PMC3528057 DOI: 10.3797/scipharm.1205-16] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/06/2012] [Indexed: 11/30/2022] Open
Abstract
Methimazole is used as an antithyroid drug to control the symptoms of hyperthyroidism and maintain patients in a euthyroid state. Administration of this drug is associated with agranulocytosis and hepatotoxicity, which are the two most significant adverse effects. The present investigation was conducted to study the protective role of taurine against cytotoxicity induced by methimazole and its proposed reactive intermediary metabolite, N-methylthiourea, in an in vitro model of isolated rat hepatocytes. At different points in time, markers such as cell viability, reactive oxygen species (ROS) formation, lipid peroxidation, mitochondrial membrane potential, and hepatocyte glutathione content were evaluated. Treating hepatocytes with methimazole resulted in cytotoxicity characterized by the reduction in cell viability, an increase in ROS formation and lipid peroxidation, mitochondrial membrane potential collapse, and a reduction in cellular glutathione content. Furthermore, a significant amount of oxidized glutathione (GSSG) was formed when rat hepatocytes were treated with methimazole. N-methylthiourea toxicity was accompanied by a reduction in cellular GSH content, but no significant changes in lipid peroxidation, ROS formation, GSSG production, or changes in mitochondrial membrane potential were detected. Administration of taurine (200 μM) effectively reduced the toxic effects of methimazole or its metabolite in isolated rat hepatocytes.
Collapse
Affiliation(s)
- Reza Heidari
- Drug Applied Research Center, Tabriz university of medical sciences, 51656-65811 Tabriz, Iran. ; Department of pharmacology and Toxicology, Faculty of Pharmacy, Tabriz University of Medical Sciences, 51656-65811 Tabriz, Iran
| | | | | |
Collapse
|
17
|
Burke JF, Sippel RS, Chen H. Evolution of pediatric thyroid surgery at a tertiary medical center. J Surg Res 2012; 177:268-74. [PMID: 22795270 DOI: 10.1016/j.jss.2012.06.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 04/06/2012] [Accepted: 06/19/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thyroidectomy in the pediatric population is often avoided due to perceived risks in children. With growing subspecialization and establishment of high volume endocrine surgery centers, the indications for thyroid surgery and extent of resection continue to change. We examined the evolution of pediatric thyroid surgery at a high volume tertiary medical center. METHODS From our prospectively collected database, we reviewed medical records of individuals younger than 19 y who underwent thyroidectomy at our institution from 1994 to 2009. Patients were divided into two groups: (1) before establishment of our endocrine surgery center (1994-2001) and (2) since establishment of the center (2002-2009). RESULTS We identified 78 operations performed on 74 patients with a median age of 15 (range 3-18) y. We found that the number of patients doubled in the later time period, with 26 operations in group 1 and 52 in group 2. The age of patients and percentage of females were similar between groups. After establishment of the endocrine surgery center, there was a significant increase in total thyroidectomies for all indications, including significantly more for benign disease. Overall, 9% of the patient population experienced transient complications, with no permanent complications or long-term sequelae. CONCLUSIONS Pediatric thyroid surgery is extremely safe, especially when performed at a high volume endocrine surgery center. We more often select surgical treatment for benign disease and choose total thyroidectomy over limited resection. This may reflect increasing confidence in the safety and efficacy of surgery and reliability of thyroid hormone replacement.
Collapse
Affiliation(s)
- Jocelyn F Burke
- Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | | | | |
Collapse
|
18
|
Karras S, Tzotzas T, Krassas GE. Toxicological considerations for antithyroid drugs in children. Expert Opin Drug Metab Toxicol 2011; 7:399-410. [PMID: 21323607 DOI: 10.1517/17425255.2011.557068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Propylthiouracil (PTU), methimazole (MMI) and carbimazole are indicated for the treatment of hyperthyroidism in adult and pediatric patients. The aim of this review is to present all the relevant information regarding the use of antithyroid drugs (ATD) in pediatric thyrotoxic cases, the pediatric toxicology of ATD and the warning which has recently been issued for PTU by the FDA. AREAS COVERED Epidemiology, diagnosis and treatment of pediatric thyrotoxicosis are all presented in this article. The authors also extensively discuss the details regarding the pharmacology, bioactivation, biodisposition, bioavailability and pharmacokinetic properties of the two main ATD (MMI and PTU). EXPERT OPINION The FDA recently reported that use of PTU is associated with a higher risk for clinically serious or fatal liver injury compared to MMI in both adult and pediatric patients. They also found that congenital malformations were reported approximately three times more often with prenatal exposure to MMI compared with PTU and especially with the use of MMI during the first trimester of pregnancy. The authors believe that PTU should not be used in pediatric patients unless the patient is allergic to or intolerant of MMI, and there are no other treatment options available. That being said, PTU may be the treatment of choice during, and just before, the first trimester of pregnancy.
Collapse
Affiliation(s)
- Spiros Karras
- Panagia General Hospital, Department of Endocrinology, Diabetes and Metabolism, N. Plastira, 22, N. Krini 55132, Thessaloniki, Greece
| | | | | |
Collapse
|