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Ghosh B, Roy N, Roy D, Mandal S, Mondal M, Dakua VK, Dutta A, Sen S, Kumar A, Chakraborty R, Roy MN. Exploring Inclusion Complex of an Antithyroid Drug (PTU) with α-Cyclodextrin for Innovative Applications by Physicochemical Approach Optimized by Molecular Docking. J Mol Liq 2023. [DOI: 10.1016/j.molliq.2023.121708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Zeng B, Yuan L, Chu J, Yang Y, Lin S. Challenges in early identification of causes and treatment of cholestasis in patients with hyperthyroidism: a case report and literature review. J Int Med Res 2019; 48:300060519891018. [PMID: 31840543 PMCID: PMC7604993 DOI: 10.1177/0300060519891018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Early identification of the causes of cholestasis is important for appropriate
management of patients with hyperthyroidism. We report a patient who had
hyperthyroidism and severe cholestasis after methimazole (MMI) treatment. The
patient was diagnosed as having MMI-induced cholestatic hepatitis. Treatment
with MMI was stopped at admission to hospital. However, his serum total
bilirubin (TBil) level rose from 410.5 µmol/L to 519.9 µmol/L and prothrombin
time activity (PTA) dropped from 81.0% to 52.2% in 10 days. To prevent further
deterioration of his liver function, plasma exchange was performed three times,
and dexamethasone (10 mg, intravenously) was used each time. His PTA rose to
101% and his TBil continued to increase to 669.8 µmol/L after plasma exchange.
He was subsequently diagnosed as having thyrotoxicosis-induced cholestasis and
treated with radioactive iodine (380 MBq) 2 weeks after admission. His
hyperthyroidism was significantly relieved, but the TBil level further increased
to 776.8 µmol/L. Three weeks after admission, oral prednisone (30 mg/day) was
used in this patient. Subsequently, his TBil levels gradually decreased and his
liver function almost normalized within 3 months. We discuss the literature on
cholestasis in the context of hyperthyroidism.
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Affiliation(s)
- Baimei Zeng
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Ling Yuan
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jun Chu
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yanqing Yang
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Shide Lin
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Chipiso K, Simoyi RH. Electrochemical versus Enzymatic in Vitro Oxidations of 6-propyl-2-thiouracil: Identification, Detection, and Characterization of Metabolites. J Phys Chem B 2017; 121:10749-10758. [PMID: 29091454 DOI: 10.1021/acs.jpcb.7b07404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
6-Propylthiouracil, PTU, is a well-known antithyroid drug that has been the mainstay of treatment of Graves' disease. It is, however, also associated with liver toxicity and idiosyncratic toxicity. These toxicities are generally associated with metabolites derived from its bioactivation. In this manuscript, bioactivation of PTU was studied via two separate techniques: electrochemical oxidation and through the use of human liver microsomes. The aim of this work was to compare the bioactivation products of these two techniques. The electrochemical technique was studied online with a mass spectrometer, EC/ESI/MS. The microsomal oxidations were studied in tandem with liquid chromatography. The EC/ESI/MS technique was devoid of the normal reducing biological matrix prevalent in microsomal incubations. The predominant product at 400 mV was the dimeric PTU species with negligible formation of other metabolites. At higher potentials, complete desulfurization of PTU was observed with formation of sulfate. No sulfonic acid was observed, suggesting that the cleavage of the C-S bond was effected at the sulfinic acid stage, releasing a highly reducing sulfur species which is known to give rise to genotoxicity. The microsomal oxidations, surprisingly, showed formation of the unstable sulfenic acid, the S-oxide. Further incubation showed both the sulfinic and sulfonic acids. None of the systems showed any adducts with nucleophiles such as glutathione, showing that none of the reactive metabolites were stable enough to be adducted to nucleophiles in both the biological matrix and the electrochemical oxidizing environment.
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Affiliation(s)
- Kudzanai Chipiso
- Department of Chemistry, Portland State University , Portland, Oregon 97207-0751, United States
| | - Reuben H Simoyi
- Department of Chemistry, Portland State University , Portland, Oregon 97207-0751, United States.,School of Chemistry and Physics, University of KwaZulu-Natal , Westville Campus, Durban 4014, South Africa
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Tatara MR, Gołyński M, Radzki RP, Bieńko M, Krupski W. Effects of long-term oral administration of methimazole on femur and tibia properties in male Wistar rats. Biomed Pharmacother 2017; 94:124-128. [PMID: 28759749 DOI: 10.1016/j.biopha.2017.07.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/27/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022] Open
Abstract
Physiological concentrations of thyroid hormones are crucial for skeletal growth and development, physiological bone turnover and bone homeostasis maintenance. Methimazole (1-methyl-2-mercaptoimidazole) is an antithyroid drug used for the treatment of the hyperthyroidism in humans and animals. The aim of the study was to determine effects of long-term oral methimazole treatment in male Wistar rats on biochemical bone metabolism markers, as well as morphological, geometric, densitometric and mechanical properties of femur and tibia. Experimental rats were subjected to 90-day-long oral treatment with 0.05% water solution of methimazole and were kept under identical environmental conditions and received the same diet ad libitum as the control group. Serum concentration of osteocalcin (OC) and C-terminal telopeptides of type I collagen (CTX-I) was determined. Femur and tibia were evaluated using quantitative computed tomography (QCT), peripheral QCT (pQCT) and three-point bending test. Final body weight of the experimental group was significantly decreased by 30% (P=0.01). Methimazole treatment significantly decreased serum OC concentration by 21% (P=0.02) and increased CTX-I concentration by 17% (P=0.06). Methimazole decreased morphological, geometric and densitometric parameters of femur and tibia in rats. Mechanical evaluation of bones has shown significantly decreased maximum elastic strength and ultimate strength of femur in rats treated with methimazole by 36% and 40% when compared to the control group (P<0.05). In conclusion, this study has shown that long-term treatment with methimazole inhibits bone formation and accelerates bone resorption processes. The observed negative effects of methimazole treatment on body weight gain and skeletal properties may be considered as additional possible side effects in living organisms to those reported in the previous studies. It may be suggested that long-term antithyroid treatment should be combined with prevention of the negative effects of methimazole on bone tissue and whole body metabolism.
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Affiliation(s)
- Marcin R Tatara
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, ul. Akademicka 12, 20-950 Lublin, Poland.
| | - Marcin Gołyński
- Sub-Department of Internal Diseases of Farm Animals and Horses, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, ul. Głęboka 30, 20-612 Lublin, Poland
| | - Radosław P Radzki
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, ul. Akademicka 12, 20-950 Lublin, Poland
| | - Marek Bieńko
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, ul. Akademicka 12, 20-950 Lublin, Poland
| | - Witold Krupski
- II Department of Radiology, Medical University in Lublin, ul. Staszica 16, 20-081 Lublin, Poland
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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]
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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.
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de Campos Mazo DF, de Vasconcelos GBS, Pereira MAA, de Mello ES, Bacchella T, Carrilho FJ, Cançado ELR. Clinical spectrum and therapeutic approach to hepatocellular injury in patients with hyperthyroidism. Clin Exp Gastroenterol 2013; 6:9-17. [PMID: 23550044 PMCID: PMC3579408 DOI: 10.2147/ceg.s39358] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Liver dysfunction in patients with hyperthyroidism includes abnormalities associated with the effects of thyroid hormone excess, those secondary to drug-induced liver injury, and changes resulting from concomitant liver disease. Our goal was to describe clinical, biochemical, and histopathological patterns in patients suffering from hyperthyroidism and concomitant liver dysfunction and to propose an algorithm of procedures to facilitate diagnosis and management of such cases. This study describes seven patients with liver biochemistry abnormalities detected after diagnosis of hyperthyroidism and one with undiagnosed decompensated hyperthyroidism and acute hepatitis. Two patients showed autoantibody reactivity which, together with liver histology, suggested the diagnosis of classic autoimmune hepatitis. Three patients experienced hepatotoxicity induced by propylthiouracil, the manifestations of which ranged from a benign course after drug withdrawal in one, a longstanding course in another suggesting drug-induced autoimmune hepatitis, and a more severe clinical condition with acute liver failure in a third patient, requiring liver transplantation. The three remaining patients showed no precipitating factors other than thyroid hyperactivity itself. They could be interpreted as having a thyroid storm with different clinical presentations. In conclusion, this series of patients illustrates the most frequent patterns of hepatocellular damage associated with hyperthyroidism and provides an algorithm for their diagnosis and treatment.
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Affiliation(s)
- Daniel Ferraz de Campos Mazo
- Department of Gastroenterology, Institute of Tropical Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
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Chen L, Zhao X, Liu H, Wang Y, Li L, Lu B, Li Y, Hu R. Mean peak systolic velocity of the superior thyroid artery is correlated with radioactive iodine uptake in untreated thyrotoxicosis. J Int Med Res 2012; 40:640-7. [PMID: 22613425 DOI: 10.1177/147323001204000226] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between mean superior thyroid artery peak systolic velocity (STA-PSV) and radioactive iodine uptake (RAIU) in Chinese patients with untreated thyrotoxicosis, using retrospectively and prospectively collected data. METHODS Patients with untreated thyrotoxicosis (n = 220) and euthyroid control subjects (n = 30) underwent thyroid function, thyroid autoantibody and thyroid ultrasonography tests. Mean STA-PSV was measured by ultrasonography. RAIU tests identified 168 patients with Graves' disease and 52 with destructive thyroiditis. Linear correlation of mean STA-PSV with 3-h and 24-h RAIU, and sensitivity, specificity and receiver operating characteristic (ROC) curves for mean STA-PSV in the differential diagnosis of Graves' disease and destructive thyroiditis were calculated. RESULTS Mean STA-PSV was significantly higher in Graves' disease than in destructive thyroiditis. Mean STA-PSV correlated positively and significantly with 3-h and 24-h RAIU. Area under the ROC curve of mean STA-PSV for the differential diagnosis of Graves' disease and destructive thyroiditis was 0.825 (optimum cut-off value of mean STA-PSV, 45.25 cm/s; sensitivity, 80.4%; specificity, 81.4%). CONCLUSIONS Detection of mean STA-PSV by ultrasonography agrees with RAIU and is useful for the differential diagnosis of thyrotoxicosis in Chinese patients.
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Affiliation(s)
- L Chen
- Department of Endocrinology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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[Methimazole-induced liver injury]. FARMACIA HOSPITALARIA 2012; 36:431-2. [PMID: 22857866 DOI: 10.1016/j.farma.2011.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/25/2011] [Accepted: 03/06/2011] [Indexed: 11/21/2022] Open
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Hyperthyroidism due to Graves-Basedow disease in a woman refractory to thyroid hormones. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2012; 59:609-11. [PMID: 22425314 DOI: 10.1016/j.endonu.2011.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/22/2011] [Accepted: 11/25/2011] [Indexed: 11/20/2022]
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Xie F, Zhou X, Genter MB, Behr M, Gu J, Ding X. The tissue-specific toxicity of methimazole in the mouse olfactory mucosa is partly mediated through target-tissue metabolic activation by CYP2A5. Drug Metab Dispos 2011; 39:947-51. [PMID: 21415250 DOI: 10.1124/dmd.110.037895] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The antithyroid drug methimazole (MMZ) can cause severe, tissue-specific toxicity in mouse olfactory mucosa (OM), presumably through a sequential metabolic activation of MMZ by cytochrome P450 (P450) and flavin monooxygenases (FMO). The aims of this study were to determine whether CYP2A5, one of the most abundant P450 enzymes in the mouse OM, is involved in MMZ metabolic activation, by comparing Cyp2a5-null with wild-type (WT) mice, and whether hepatic microsomal P450 enzymes, including CYP2A5, are essential for MMZ-induced OM toxicity, by comparing liver-Cpr-null (LCN) mice, which have little P450 activity in hepatocytes, with WT mice. We showed that the loss of CYP2A5 expression did not alter systemic clearance of MMZ (at 50 mg/kg, i.p.); but it did significantly decrease the rates of MMZ metabolism in the OM, whereas FMO expression in the OM was not reduced. MMZ induced depletion of nonprotein thiols, as well as pathological changes, in the OM of WT mice; the extent of these changes was much reduced in the Cyp2a5-null mice. Thus, CYP2A5 plays an important role in mediating MMZ toxicity in the OM. In contrast, the rate of systemic clearance of MMZ was significantly reduced in the LCN mice, compared to WT mice, whereas the MMZ-induced OM toxicity was not prevented. Therefore, hepatic P450 enzymes are essential for systemic MMZ clearance, but they are not required for MMZ-induced OM toxicity. We conclude that the tissue-specific toxicity of MMZ is mediated by target tissue metabolic activation, and the reaction is partly catalyzed by CYP2A5 in the OM.
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Affiliation(s)
- Fang Xie
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
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Ortiz-ButrÓn R, Blas-Valdivia V, Franco-Colin M, Pineda-Reynoso M, Cano-Europa E. An increase of oxidative stress markers and the alteration of the antioxidant enzymatic system are associated with spleen damage caused by methimazole-induced hypothyroidism. Drug Chem Toxicol 2011; 34:180-8. [DOI: 10.3109/01480545.2010.495391] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cano-Europa E, Blas-Valdivia V, Franco-Colin M, Gallardo-Casas CA, Ortiz-Butrón R. Methimazole-induced hypothyroidism causes cellular damage in the spleen, heart, liver, lung and kidney. Acta Histochem 2011; 113:1-5. [PMID: 19775732 DOI: 10.1016/j.acthis.2009.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 06/23/2009] [Accepted: 07/06/2009] [Indexed: 11/30/2022]
Abstract
It is known that a hypothyroidism-induced hypometabolic state protects against oxidative damage caused by toxins. However, some workers demonstrated that antithyroid drug-induced hypothyroidism can cause cellular damage. Our objective was to determine if methimazole (an antithyroid drug) or hypothyroidism causes cellular damage in the liver, kidney, lung, spleen and heart. Twenty-five male Wistar rats were divided into 5 groups: euthyroid, false thyroidectomy, thyroidectomy-induced hypothyroidism, methimazole-induced hypothyroidism (60 mg/kg), and treatment with methimazole (60 mg/kg) and a T₄ injection (20 μg/kg/d sc). At the end of the treatments (4 weeks for the pharmacological groups and 8 weeks for the surgical groups), the animals were anesthetized with sodium pentobarbital and they were transcardially perfused with 10% formaldehyde. The spleen, heart, liver, lung and kidney were removed and were processed for embedding in paraffin wax. Coronal sections were stained with hematoxylin-eosin. At the end of treatment, animals with both the methimazole- and thyroidectomy-induced hypothyroidism had a significant reduction of serum concentration of thyroid hormones. Only methimazole-induced hypothyroidism causes cellular damage in the kidney, lung, liver, heart, kidney and spleen. In addition, animals treated with methimazole and T₄ showed cellular damage in the lung, spleen and renal medulla with lesser damage in the liver, renal cortex and heart. The thyroidectomy only altered the lung structure. The alterations were prevented by T₄ completely in the heart and partially in the kidney cortex. These results indicate that tissue damage found in hypothyroidism is caused by methimazole.
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Affiliation(s)
- Edgar Cano-Europa
- Departamento de Fisiología "Mauricio Russek Berman", Escuela Nacional de Ciencias Biológicas, I.P.N., Carpio y Plan de Ayala, México, D.F., C.P., Mexico
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[Acute toxic hepatitis induced by methimazole: two cases]. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2010; 57:451-3. [PMID: 20675204 DOI: 10.1016/j.endonu.2010.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/27/2010] [Accepted: 05/06/2010] [Indexed: 11/21/2022]
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