Thyroid Ablation As Graves’ Disease Treatment Modality in Methimazole-Induced Drug-Induced Liver Injury

Abstract

Methimazole (MMI)-related drug-induced liver injury (DILI) in Graves’ Disease (GD) patients is rare and the other antithyroid drugs (ATD) also have DILI risk as MMI. This case report illustrated DILI disease course in the patient and explored the other therapeutic modality option. A 39-year-old woman came to emergency room (ER) due to yellowish color and itching in all of her body for one week. She also complained nauseous, bloating, tea colored urine and putty colored stool. She was diagnosed GD 3 months prior and received MMI as her treatment. Her sclera was icteric and her liver function test increased in both transaminase (Aspartate Aminotransferase (AST) 118, Alanine Aminotransferase (ALT) 187) and hyperbilirubinemia (total bilirubin 10.56, direct bilirubin 6.54). Per exclusion, she was diagnosed MMI-related DILI. Therefore, her MMI treatment was stopped and thyroid ablation was received. Two days after her ablation, she showed significant clinical improvement and was discharged. MMI-related DILI in GD patients is rare but life threatening. Thyroid ablation is a therapeutic modality option in GD management.