Journal article
Clinical Characteristics and Outcomes of Patients With Antithyroid Drug-Related Liver Injury
Journal of the Endocrine Society, v 8(1), bvad133
01 Jan 2024
PMID: 38178906
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.
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Details
- Title
- Clinical Characteristics and Outcomes of Patients With Antithyroid Drug-Related Liver Injury
- Creators
- Adeel Ahmad Khan (Corresponding Author) - Hamad Medical CorporationFateen Ata - Hamad Medical CorporationAfia Aziz - Hamad Medical CorporationHana Elamin - National UniversityAamir Shahzad - Reading HospitalZohaib Yousaf - Reading HospitalAnthony Donato - Reading Hospital
- Publication Details
- Journal of the Endocrine Society, v 8(1), bvad133
- Publisher
- Oxford University Press
- Number of pages
- 10
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate); General Internal Medicine
- Web of Science ID
- WOS:001136583100002
- Scopus ID
- 2-s2.0-85182238260
- Other Identifier
- 991022161834204721