Non-viral liver disease
Michael JG Farthing, Anne B Ballinger in Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Propylthiouracil has been proposed as a treatment of alcoholic hepatitis, despite reports of hepatotoxicity, including some fatalities, in an attempt to slow the hypermetabolic state and relative hypoxia that occurs in the central vein areas of the liver. Following an early study that indicated that propylthiouracil hastened clinical improvement in patients with alcoholic liver disease, Orrego et al. conducted a doubleblind placebo-controlled study to determine the effect of long-term treatment on survival.99 In contrast to Halle et al.100 who failed to find any beneficial effect, Orrego et al. found that, during their 2-year study, the 13% mortality rate in patients receiving propylthiouracil 300 mg daily was significantly lower than the 25% mortality rate in patients receiving placebo. The main effect of propylthiouracil appeared to be on acute alcoholic hepatitis since the difference in mortality rate was greatest during the first 12 weeks. Although subgroup analysis indicated that the effect was greater in severely ill patients, the validity of this result is considered to be uncertain as the patients had not been randomized according to the severity of their disease on entry to the study. Lashner and Baker criticized the results of Orrego et al. on the basis that their statistical analysis was inappropriate to the objective of the study and they suggested there was no convincing evidence for a beneficial effect of propylthiouracil in alcoholic liver disease.101 Sherlock has commented that propylthiouracil has not gained general acceptance for the treatment of alcoholic liver disease.102
Benign Thyroid Disease
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
All patients with hyperthyroidism require specialist referral and patients should be commenced on antithyroid drug treatment while they await further clinical review.65 Carbimazole is available as 5 mg and 20 mg tablets and is usually given in a starting dose of 20–30 mg per day in a single dose. Treatment should usually begin at 30 mg in cases of severe disease (fT3 and fT4 levels more than twice the upper limit of the normal reference range). Propylthiouracil is given in divided doses, with a dose of 200 mg approximately equivalent to 20 mg carbimazole. Patients begin to feel an improvement at 10–14 days and fT4 and fT3 values return to normal levels over 4–6 weeks.
Endocrinology and metabolism
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan in Essential Notes for Medical and Surgical Finals, 2021
Medical Propranolol may be symptomatically useful initially.Antithyroid drugs (carbimazole, propylthiouracil): side effects of rash, joint pains, agranulocytosis. Propylthiouracil preferred in pregnancy.Radioiodine: used first line for some patients with Graves’ or toxic MNG, those who have relapsed after initial drug treatment or allergies to drug treatment.
Propylthiouracil-induced ANCA-negative cutaneous small vessel vasculitis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Aliaksandr Trusau, Michael L. Brit
Propylthiouracil (PTU) is a commonly used medication for the treatment of hyperthyroidism. PTU is known to cause different adverse reactions including fever, skin lesions, arthralgia, myalgia, blood dyscrasia, hepatotoxicity, and autoimmune syndromes [1,2]. Patients with thyroid disease may be prone to develop drug-induced autoimmune diseases [3]. PTU-induced autoimmune syndromes can be classified into drug-induced lupus (DIL) or drug-induced vasculitis (DIV) based on definitions, clinical features, and serological features [4]. Many of autoimmune diseases including systemic lupus erythematosus (SLE), DIL, DIV, and idiopathic antineutrophil cytoplasm antibody (ANCA) vasculitis share similar clinical features and laboratory markers [5]. An accurate diagnosis is essential, because it determines further management. We report a rare case of ANCA-negative cutaneous small vessel vasculitis (CSVV) as a result of longstanding exposure to PTU.
Prolonged coma resulting from massive levothyroxine overdose and the utility of N-terminal prohormone brain natriuretic peptide (NT-proBNP)
Published in Clinical Toxicology, 2019
Ophelia Wong, Anselm Wong, Shaun Greene, Andis Graudins
Treatment of thyrotoxicosis and toxicity after levothyroxine overdose is similar. Thyroid storm is treated using principles highlighted by Idrose [7]:Supportive care – management of dehydration, fever, cardiac monitoring and glucose.Inhibition of new thyroid hormone synthesis, e.g., propylthiouracil or methimazole.Inhibition of thyroid hormone release, e.g., iodine with Lugol solution.Beta adrenergic receptor blockade, e.g., propranolol.Preventing peripheral conversion of T4 to T3, e.g., steroids, propranolol and propylthiouracil.Treat the underlying cause.
Acute appendicitis complicated by concomitant thyroid storm
Published in Baylor University Medical Center Proceedings, 2021
Michael M. Mohseni, Charles Graham
Intraoperatively, the patient had perforated appendicitis with phlegmon by the liver edge. After abscess irrigation and appendectomy, a drain was placed with the tip in the right paracolic region. Intravenous dexamethasone, piperacillin-tazobactam, and esmolol were continued. On postoperative day 1, the patient was cleared for oral medications, and oral propylthiouracil 250 mg every 4 hours was initiated. Given her severe intolerance to propranolol, she was maintained on an esmolol drip. On postoperative day 3, she transitioned to methimazole 10 mg and oral atenolol 25 mg, both twice a day. Repeat T4 and T3 levels were 2.0 ng/dL and 43 ng/dL, respectively. She was discharged that same evening after removal of her drain and prescribed 10 days of amoxicillin/clavulanate 875 to 125 mg. At 2-week follow-up, her incisional staples were removed without event.
Related Knowledge Centers
- Hyperthyroidism
- Graves' Disease
- Toxic Multinodular Goitre
- Thyroid Storm
- Thiamazole
- Isotopes of Iodine
- Oral Administration
- Liver Disease
- Cytopenia
- Antithyroid Agent