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Age and Ageing 2006 35(3):319; doi:10.1093/ageing/afj068
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© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Clinical Reminder

Cholestatic jaundice following carbimazole therapy in an elderly thyrotoxic patient

Hasan Haboubi, Dylan Harris and Nadim Haboubi*

Department of Adult Medicine, Nevill Hall Hospital, Brecon Road, Abergavenny NP7 7EG, UK

* To whom correspondence should be addressed Email: nadim.haboubi{at}gwent.wales.nhs.uk

An 81-year-old lady with dyspnoea and palpitations was found to be in atrial fibrillation with a rate of 130 bpm.

She remained tachycardic despite digitalisation, and a thyroid function test revealed a low TSH (<1.0 mµ/l) and high T4 (28 µg/dl).

Carbimazole 20 mg was commenced. However, 3 weeks later, the patient became jaundiced (bilirubin 144 µmol/l, ALP 1192 iµ/l and ALT 289 iµ/l). Abdominal ultrasound, viral hepatitis titres and autoantibodies were normal.

Carbimazole was replaced by Propylthiouracil and within three days liver biochemistry began improving and two months later had normalised.

Side-effects of carbimazole include rash, pruritus and agranulocytosis [1]. Cholestasis is a rare side-effect [2]. Recent reports of cholestatic jaundice caused by sequential carbimazole and propylthiouracil suggest the possibility of crossover reactivity [3] but fortunately our patient recovered on stopping carbimazole.

Carbimazole may induce fulminant hepatitis and we suggest periodic monitoring of liver function tests because early detection of drug-induced cholestasis is required to minimise the risk of potentially fatal consequences.


   References
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 References
 

  1. Bartalena L, Bogazzi F, Martino E. Adverse effects of thyroid hormone preparations and antithyroid drugs. Drug Saf 1996; 15: 53–63.[Web of Science][Medline]
  2. Ayensa C. Diaz de Otazu R, Cia JM. Carbimazole-induced cholestatic hepatitis. Arch Intern Med 1986; 146: 1455.
  3. Chan AO, Ng IO, Lam SM, Shek TW, Lai CL. Cholestatic jaundice caused by sequential carbimazole and propylthiouracil treatment for thyrotoxicosis. Hong Kong Med J 2003; 9: 377–80.[Medline]doi:10.1093/ageing/afj068

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This Article
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