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1
Perger, Ludwig, Ulrich Bürgi, and Karin Fattinger. "Pharmakotherapie bei Hyperthyreose - unerwünschte Arzneimittelwirkungen." Therapeutische Umschau 68, no. 6 (June 1, 2011): 303–8. http://dx.doi.org/10.1024/0040-5930/a000169.
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Als Thyreostatika werden heute Thioimidazole (Carbimazol, Methimazol = Thiamazol) und Propylthiouracil eingesetzt. Carbimazol wird im Körper in Methimazol umgewandelt; ein Wechsel zwischen diesen Substanzen bringt bei Nebenwirkungen nichts. Des Weiteren kommt es bei Nebenwirkungen zwischen Thioimidazolen und Propylthiouracil manchmal zu Kreuzreaktionen. Zu den häufigen und typische Nebenwirkungen der Thyreostatika gehört eine dosisabhängige Hypothyreose, die Schilddrüsenfunktion soll deshalb regelmäßig überwacht werden. Weiter kann es zu Juckreiz und Hautausschlag kommen; hier kann man einen Wechsel der Substanz versuchen. Neben einer milden, dosisabhängigen Neutropenie, kann es vor allem in den ersten drei Monaten auch zu einer schweren Agranulozytose (3 per 10'000 Patienten, Kreuzreaktionen möglich) und sehr selten zu aplastischer Anämie kommen. Vor allem unter Propylthiouracil, aber selten auch unter Methimazol können ein asymptomatischer, transienter Leberenzymanstieg, aber auch schwere, ja tödlich verlaufende cholestatische oder hepatozelluläre Leberschäden auftreten. Wegen der Häufung von Propylthiouracil-bedingtem Leberversagen bei Kindern und Jugendlichen, sollte man hier präferentiell Thioimidazole einsetzen. Wegen dieser schweren Nebenwirkungen sollen Patienten unter Thyreostatika angewiesen werden, sich bei Auftreten von Fieber oder Halsschmerzen bzw. Malaise, Oberbauchbeschwerden und Ikterus umgehend beim Arzt zu melden. Des Weiteren kann es unter beiden Substanzen bei 1 - 5 % zu Arthralgien kommen. Da sich daraus schwere immunologische Nebenwirkungen entwickeln können, sollen die Thyreostatika dann abgesetzt werden. Eine Polyarthritis tritt vor allem in den ersten Monaten der Therapie auf, während ANCA-positive Vasculitiden oft erst nach langer Therapiedauer mit Propylthiouracil oder sehr selten unter Methimazol auftreten können. Das teratogene Risiko ist bei den Thioimidazolen höher (Aplasia cutis congenita), weswegen in der Schwangerschaft Propylthiouracil bevorzugt werden soll. In der Stillzeit können sowohl Thioimidazole als auch Propylthiouracil verabreicht werden. Perchlorat wir heute kaum mehr verwendet. Deswegen sind die früher unter längerer Therapie mit Perchlorat beobachteten Nebenwirkungen heute kaum mehr ein Thema.
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Laurberg, P., J. Tørring, and J. Weeke. "A comparison of the effects of propylthiouracil and methimazol on circulating thyroid hormones and various measures of peripheral thyroid hormone effects in thyrotoxic patients." Acta Endocrinologica 108, no. 1 (January 1985): 51–54. http://dx.doi.org/10.1530/acta.0.1080051.
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Abstract. Two groups of patients with newly diagnosed thyrotoxicosis were treated with propylthiouracil (PTU) 400 mg every 6 h for 4 days followed by methimazol (MMI) 40 mg every 6 h for 4 days or by MMI for 4 days followed by PTU for 4 days. The shift from MMI to PTU induced a considerable decrease in serum T3 while shift from PTU to MMI led to an increase in serum T3. Serum T4 decreased gradually during the whole treatment period. The opposite variations in serum T3 were accompanied by similar opposite variations in basal metabolic rate (BMR) (P < 0.001). Hence the rapid variations in serum T3 which can be induced by PTU in thyrotoxic patients, are followed by rapid alterations in the thyrotoxic state as evaluated by BMR.
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Frank-Raue, Karin. "Schilddrüse und Schwangerschaft." Der Klinikarzt 48, no. 12 (December 2019): 541–45. http://dx.doi.org/10.1055/a-1061-0678.
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ZUSAMMENFASSUNGIn der Schwangerschaft nimmt die Produktion von Thyroxin um etwa 50 % zu, der Jodbedarf steigt, das Schilddrüsenvolumen nimmt zu. Die Therapie von Schilddrüsenerkrankungen betrifft Mutter und Kind, die Plazentagängigkeit von Jod, Thyreostatika und TSH-Rezeptorantikörpern in höheren Titern ist zu beachten, Thyroxin ist nur partiell plazentagängig.Im 1. Trimenon ist die meist milde durch hCG-Stimulation bedingte Schwangerschaftshyperthyreose die häufigste Ursache einer Hyperthyreose, sie ist meist nicht behandlungsbedürftig. Die Hyperthyreose bei M. Basedow tritt in etwa 0,2 % der Schwangerschaften auf; Therapieindikation ist die manifeste Hyperthyreose. In der Frühschwangerschaft wird mit Propylthiouracil, ab dem 2. Trimenon mit Methimazol/Carbimazol behandelt.Die Hypothyreose der Mutter ist mit Schwangerschaftskomplikationen und Entwicklungsstörungen des Kindes assoziiert. Die Thyroxindosis muss bereits in der Frühschwangerschaft erhöht werden. Die Behandlung von TSH-Spiegeln zwischen 2,5–4 mIU/l verbessert weder die Abortrate noch die fetale kognitive Entwicklung. Eine L-Thyroxintherapie ist ab einer TSH-Erhöhung von 4 mIU/l indiziert.
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Arizmendi Diana Elizabeth, Díaz, and Mendieta Zerón Hugo. "Degree of Control and Main Complications of Hyperthyroid Pregnant Women in a Real Life Experience with Methimazol." American Journal of Internal Medicine 8, no. 1 (2020): 19. http://dx.doi.org/10.11648/j.ajim.20200801.14.
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Tu, Changqing, and Xinrong Wen. "Determination of Cysteine by Discoloration Spectrophotometry using Copper(II)-Bis-Cyclohexanone Oxalydihydrazone." E3S Web of Conferences 245 (2021): 03023. http://dx.doi.org/10.1051/e3sconf/202124503023.
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In the alkaline medium of pH=9.18, Cu2+ can be reduced to Cu+ by the sulfhydryl (-SH) of cysteine, and it result in the decrease the amount of Cu2+ in the system. The decrement of Cu2+ is directly proportional to the addition of cysteine, then using bis-cyclohexanone oxalyldihydrazone (BCO) as chromogenic reagent for Cu2+ to determinate the content of cysteine indirectly by discoloration spectrophotometry. A new method for the determination of cysteine by discoloration spectrophotometry using Copper(II)-BCO has been established. The influencing factors of the determination of cysteine is investigated. The results show that the maximum absorption wavelength of chromogenic system was 602 nm, in the range of 0.008000~0.06800 mg/mL, the linear relationship between the decrease of absorbance and the mass concentration of methimazol is A=0.2162+2.4824C (mg/mL), and the linear correlation coefficient is r=0.9959. The method has been applied to the determination of cysteine in food, and the results are basically consistent with those determined by pharmacopoeial method.
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Mano, T., R. Sinohara, Y. Sawai, N. Oda, Y. Nishida, T. Mokuno, K. Asano, et al. "Changes in lipid peroxidation and free radical scavengers in the brain of hyper- and hypothyroid aged rats." Journal of Endocrinology 147, no. 2 (November 1995): 361–65. http://dx.doi.org/10.1677/joe.0.1470361.
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Abstract To determine how lipid peroxides and free radical scavengers are changed in the brain of hyper- or hypothyroid rats, we examined the behavior of lipid peroxide and free radical scavengers in the cerebral cortex of aged (1·5 years old) rats that had been made hyper- or hypothyroid by the administration of thyroxine or methimazol for 4 weeks. Concentrations of catalase, Mn-superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) were increased in hyperthyroid rats compared with euthyroid rats. Concentrations of total SOD, Cu,Zn-SOD and GSH-PX were increased but that of Mn-SOD was decreased in hypothyroid animals. There were no differences among hyperthyroid, hypothyroid and euthyroid rats in the levels of coenzymes 9 or 10. The concentration of lipid peroxides, determined indirectly by the measurement of thiobarbituric acid reactants, was decreased in hyperthyroid rats but not in hypothyroid rats when compared with euthyroid animals. These findings suggest that free radicals and lipid peroxides are scavenged to compensate for the changes induced by hyper- or hypothyroidism. Journal of Endocrinology (1995) 147, 361–365
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Mano, T., R. Sinohara, Y. Sawai, N. Oda, Y. Nishida, T. Mokuno, M. Kotake, et al. "Effects of thyroid hormone on coenzyme Q and other free radical scavengers in rat heart muscle." Journal of Endocrinology 145, no. 1 (April 1995): 131–36. http://dx.doi.org/10.1677/joe.0.1450131.
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Abstract Active oxygen species are reported to cause organ damage. This study was therefore designed to determine the behaviour of antioxidants and free radical scavengers so as to reveal changes in animals in the hyper- and hypothyroid state. Levels of antioxidant factors (i.e. coenzyme Q (CoQ)10, CoQ9 and vitamin E) and free radical scavengers (catalase, glutathione peroxidase (GSH-PX) and superoxide dismutase (SOD)) were measured in the heart muscles of rats rendered hyper- or hypothyroid by 4 weeks of thyroxine (T4) or methimazol treatment. Serum levels of CoQ9 and total SOD were also measured. A significant reduction in CoQ9 levels was observed in the heart muscles of both hyper- and hypothyroid rats when compared with control hearts. There was no difference in serum CoQ9 levels in thyroid dysfunction when compared with control animals. Levels of vitamin E in the heart muscles of hyperthyroid rats were significantly increased, and there was no reduction in vitamin E levels in hypothyroid rats when compared with control hearts. GSH-PX levels in the heart muscle were reduced in hyperthyroid rats and increased in hypothyroid rats when compared with control hearts. However, there were no differences in catalase levels in heart muscle between hyper- and hypothyroid rats. The concentration of SOD in heart muscle was increased in hyperthyroid rats and was not decreased in hypothyroid rats compared with control rats, suggesting the induction of SOD by excessive production of O2−. These data suggest that the changes in these scavengers have some role in cardiac dysfunction in the hyper- and hypothyroid state in the rat. Journal of Endocrinology (1995) 145, 131–136
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Sykora, Matus, Barbara Szeiffova Bacova, Tamara Egan Benova, Miroslav Barancik, Jitka Zurmanova, Hana Rauchova, Peter Weismann, et al. "Cardiac Cx43 and ECM Responses to Altered Thyroid Status Are Blunted in Spontaneously Hypertensive versus Normotensive Rats." International Journal of Molecular Sciences 20, no. 15 (August 1, 2019): 3758. http://dx.doi.org/10.3390/ijms20153758.
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Heart function and its susceptibility to arrhythmias are modulated by thyroid hormones (THs) but the responsiveness of hypertensive individuals to thyroid dysfunction is elusive. We aimed to explore the effect of altered thyroid status on crucial factors affecting synchronized heart function, i.e., connexin-43 (Cx43) and extracellular matrix proteins (ECM), in spontaneously hypertensive rats (SHRs) compared to normotensive Wistar Kyoto rats (WKRs). Basal levels of circulating THs were similar in both strains. Hyperthyroid state (HT) was induced by injection of T3 (0.15 mg/kg b.w. for eight weeks) and hypothyroid state (HY) by the administration of methimazol (0.05% for eight weeks). The possible benefit of omega-3 polyunsaturated fatty acids (Omacor, 200 mg/kg for eight weeks) intake was examined as well. Reduced levels of Cx43 in SHRs were unaffected by alterations in THs, unlike WKRs, in which levels of Cx43 and its phosphorylated form at serine368 were decreased in the HT state and increased in the HY state. This specific Cx43 phosphorylation, attributed to enhanced protein kinase C-epsilon signaling, was also increased in HY SHRs. Altered thyroid status did not show significant differences in markers of ECM or collagen deposition in SHRs. WKRs exhibited a decrease in levels of profibrotic transforming growth factor β1 and SMAD2/3 in HT and an increase in HY, along with enhanced interstitial collagen. Short-term intake of omega-3 polyunsaturated fatty acids did not affect any targeted proteins significantly. Key findings suggest that myocardial Cx43 and ECM responses to altered thyroid status are blunted in SHRs compared to WKRs. However, enhanced phosphorylation of Cx43 at serine368 in hypothyroid SHRs might be associated with preservation of intercellular coupling and alleviation of the propensity of the heart to malignant arrhythmias.
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Shell, Abigail, and Joshua W. Sullivan. "Acute Kidney Injury Following Methimazole Initiation: A Case Report." Journal of Pharmacy Practice 33, no. 1 (August 15, 2018): 99–101. http://dx.doi.org/10.1177/0897190018789277.
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Objective: Nephritis has been rarely associated with methimazole, primarily in the development of nephrotic syndrome. We describe a case of acute kidney injury without evidence of nephrotic syndrome following methimazole initiation. Methods: We present the relevant history, laboratory data, and nuclear medicine data and review relevant documentation from the literature. Results: A 72-year-old male recently diagnosed with new-onset atrial fibrillation was found to have suppressed thyroid-stimulating hormone (TSH) levels; elevated free T3, T4, and thyroid-stimulating immunoglobulin (TSI) levels; and a nonnodular thyroid gland with normal iodine uptake. He was diagnosed with Graves’ disease and treated with propylthiouracil (PTU) for 5 years. When his poor compliance with PTU was impeding his antithyroid treatment, he was converted to methimazole. Within 1 month following methimazole initiation, his serum creatinine (SCr) had risen to 1.6× baseline in the absence of other contributing nephrotoxins. SCr returned to baseline within 2 weeks of methimazole discontinuation, and the patient was subsequently managed on PTU. Conclusion: Acute kidney injury with or without the presence of nephrotic syndrome may occur during treatment with methimazole. Renal function should be closely monitored after the initiation of methimazole to prevent progressive renal dysfunction.
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Elfarra, Adnan A., Renee J. Duescher, Peter J. Sausen, Todd M. O'Hara, and A. James Cooley. "Methimazole protection of rats against gentamicin-induced nephrotoxicity." Canadian Journal of Physiology and Pharmacology 72, no. 10 (October 1, 1994): 1238–44. http://dx.doi.org/10.1139/y94-176.
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Methimazole was previously shown to protect rats, mice, and (or) dogs against cisplatin-, cephaloridine-, 2-bromohydro-quinone-, and S-(1,2-dichlorovinyl)-L-cysteine-induced nephrotoxicity. In this study, methimazole effects on gentamicin (GM) induced nephrotoxicity were examined. Rats given GM (40 mg/kg) twice daily for 10 days exhibited higher blood urea nitrogen (BUN) concentrations and severe necrosis of virtually all proximal tubules compared with saline-treated controls. Rats cotreated with methimazole (20 mg/kg) exhibited minimal proximal tubular necrosis and were protected against GM-induced increase in BUN concentrations, despite having higher kidney GM concentrations. Rats given GM alone for 3 days exhibited no proximal tubular necrosis and no elevation of BUN values. However, these rats exhibited an increase in nonprotein disulfide concentrations and a decrease in renal protein thiol and protein disulfide concentrations, as opposed to rats given GM and methimazole. Together the results show that methimazole was an effective antagonist of GM-induced nephrotoxicity. Methimazole did not inhibit GM renal uptake but may protect against GM-induced nephrotoxicity by acting as an antioxidant within the kidneys.Key words: nephrotoxicity, gentamicin, methimazole, protein thiols, nonprotein thiols.
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Tu, Chang Qing, and Xin Rong Wen. "Indirect Determination of Methimazole in Pharmaceutical Sample by Discoloration Spectrophotometry Using Fe (III)-Tiron System." Advanced Materials Research 781-784 (September 2013): 115–19. http://dx.doi.org/10.4028/www.scientific.net/amr.781-784.115.
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A novel method for the indirect determination of methimazole by discoloration spectrophotometry using Fe (Ш)-tiron system has been established.The various effect factors on the determination of methimazole by discoloration spectrophotometry using tiron-Fe (Ш) system were investigated in detail. The results showed that by controlling pH=2.8,Fe (Ш) could be reduced to Fe (II) by hydrosulfuryl (-SH) in methimazole molecule,and then using tiron as chromogenic reagent of Fe (Ш),and the content of methimazole was determinated indirectly through determinating the surplus content of Fe (Ш) in the system.The maximum absorption wavelength of chromogenic system was 663 nm, good linear relationship was obtained between A and the concentration of methimazole in the range of 3.2~12.8μg·mL-1,the equation of the linear regression was A=-0.1849+57.277ρ (mg·mL-1),with a linear correlation coefficient was 0.9998.This proposed method had been successfully applied to determinate of methimazole in real pharmaceutical.
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Wen, Xin Rong, and Chang Qing Tu. "Indirect Spectrophotometric Determination of Methimazole Using Phenanthroline-Fe(II)." Advanced Materials Research 634-638 (January 2013): 101–5. http://dx.doi.org/10.4028/www.scientific.net/amr.634-638.101.
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A novel method for the indirect determination of methimazole by spectrophotometry using phenanthroline-Fe(Ⅱ) has been established.The results showed that in acid medium, Fe(Ш) could be reduced to Fe(Ⅱ) by hydrosulfuryl(-SH) in methimazole molecule,and then using phenanthroline as chromogenic reagent of Fe(Ⅱ), and the content of methimazole was determinated indirectly through determinating the content of Fe(Ⅱ) by spectrophotometry. The various effect factors on the determination of methimazole by spectrophotometry using phenanthroline-Fe(Ⅱ) were investigated in detail.The maximum absorption wavelength of chromogenic system was 509 nm, good linear relationship was obtained between the absorbance and the concentration of methimazole in the range of 0.0016～0.0064 mg/mL,the equation of the linear regression was A = 0.1942 + 64.598ρ (mg•mL-1),with a linear correlation coefficient was 0.9995.This proposed method had been applied to determinate of methimazole in real pharmaceutical,and the results agreed well with those obtained by pharmacopoeial method.
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Vargas, Félix, Antonio Fernandez-Rivas, and Antonio Osuna. "Effects of methimazole in the early and established phases of NG-nitro-l-arginine methyl ester hypertension." European Journal of Endocrinology 135, no. 4 (October 1996): 506–13. http://dx.doi.org/10.1530/eje.0.1350506.
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Vargas F, Fernandez-Rivas A, Osuna A. Effects of methimazole in the early and established phases of NG-nitro 4643 c-nitro-l-arginine methyl ester hypertension. Eur J Endocrinol 1996;135:506–13. ISSN 0804– In the present study we evaluated the effects of methimazole, an antithyroid drug, on blood pressure and other variables in the early and established phases of hypertension induced by the inhibition of nitric oxide synthesis with the oral administration of NG-nitro-l-arginine methyl ester (l-NAME), 75 mg/100 ml in the drinking water. Moreover, we also evaluated the acute pressor effect of l-NAME on systemic blood pressure in control and rats treated chronically with methimazole, administered via drinking water (30 mg/100 ml). Oral administration of methimazole maintained the blood pressure of l-NAME-treated rats at normal levels 25 days after induction of hypertension. However, after 25 days of methimazole treatment in rats made hypertensive with l-NAME (for 25 days), high blood pressure was similar in methimazole-treated and non-treated l-NAME rats, despite the fact that a hypothyroid state had been achieved in the methimazole-treated rats. Acute intravenous injection of l-NAME caused a similar increase in mean arterial pressure in control and methimazole-treated rats at the lowest dose; however, smaller pressor responses were observed with increasing doses in hypothyroid rats. These results clearly demonstrate that hypothyroidism induced by methimazole prevents, but does not reverse, l-NAME hypertension and reduces the acute pressor responsiveness to l-NAME administration. F Vargas, Departamento de Fisiología, Facultad de Medicina, E-18012, Granada, Spain
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Kurdaikar, S. S., A. Fernandes, S. V. Gandhi, P. Pattewar, and A. A. Mahajan. "Spectrophotometric Determination of Carbimazole and Its Major Impurity, Degradation Product and Metabolite: Methimazole -=SUP=-*-=/SUP=-." Оптика и спектроскопия 129, no. 7 (2021): 972. http://dx.doi.org/10.21883/os.2021.07.51090.1046-21.
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The present research work was carried out in order to develop simple, accurate and precise UV sprctrophotometric methods having comparable sensitivity as that of sophisticated chromatographic techniques. Two methods were developed namely first derivative spectrophotometry and ratio spectra derivative spectrophotometry for accurate determination of specified impurity methimazole (imp A) in presence of drug carbimazole. First derivative spectrophotometric method involves recording of zero order spectra of both the drugs carbimazole and methimazole and its mixture in the range of 200-400 nm and subsequent conversion of these spectra into first derivative spectra. The drugs carbimazole and methimazole were determined by using zero crossing wavelengths of 227 and 260 nm respectively. In the second approach, ratio spectra were recorded for carbimazole and methimazole by selecting appropriate divisor concentration and converted into first derivative spectra. The determination of carbimazole and methimazole were carried out at wavelength 226.2 and 257 nm, respectively. Both the methods were validated as per ICH guideline. The drugs carbimazole and methimazole showed linear response with good correlation coefficient and exhibited specificity, accuracy and precision within acceptable range. The second method of ratio spectra derivative spectrophotometry was found more sensitive as compare to first derivative spectrophotometry in detecting level of impurity methimazole up to 0.5% as per official specification. Hence, these developed methods can be used as alternative to sophisticated chromatographic technique for determination of assay and related impurity in bulk drug and formulation. Keywords: carbimazole, methimazole, first derivative spectrophotometry, ratio spectra derivative spectrophotometry.
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Wen, Xinrong, and Changqing Tu. "Spectrophotometric Determination of Methimazole by Silicomolybdenum Blue." E3S Web of Conferences 53 (2018): 01046. http://dx.doi.org/10.1051/e3sconf/20185301046.
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Under optimum reaction conditions, Ammonium silicomolybdate could be quantitatively reduced to silicomolybdenum blue by hydrosulfuryl(-SH) in methimazole molecule, and the content of methimazole was determinated indirectly through determinating the absorbance of the silicomolybdenum blue. A novel method for the spectrophotometric determination of methimazole by silicomolybdenum blue has been established. The results showed that the maximum absorption wavelength of silicomolybdenum blue is 730 nm, good linear relationship is obtained between the absorbance of silicomolybdenum blue and the concentration of methimazole in the range of 8.000-160.0μg/mL, and the equation of the linear regression is A=0.0757+11.547ρ (mg/mL) with a linear correlation coefficient is 0.9998. This proposed method has been applied to determinate of methimazole in tablets, and the results agree well with those obtained by pharmacopoeial method.
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Hietarinta, M., and R. Merilahti-Palo. "Methimazole-induced Arthritis." Scandinavian Journal of Rheumatology 18, no. 1 (January 1989): 61–62. http://dx.doi.org/10.3109/03009748909095405.
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Rafter, Gale W. "Methimazole and Arthritis." Scandinavian Journal of Rheumatology 19, no. 5 (January 1990): 385. http://dx.doi.org/10.3109/03009749009096795.
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Polatli, Mehmet. "Methimazole-Induced Asthma?" Chest 121, no. 1 (January 2002): 305. http://dx.doi.org/10.1378/chest.121.1.305.
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Grembiale, Rosa Daniela, and Girolamo Pelaia. "Methimazole-Induced Asthma?" Chest 121, no. 1 (January 2002): 305–6. http://dx.doi.org/10.1016/s0012-3692(15)34690-0.
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Woeber, Kenneth A. "METHIMAZOLE-INDUCED HEPATOTOXICITY." Endocrine Practice 8, no. 3 (May 2002): 222–24. http://dx.doi.org/10.4158/ep.8.3.222.
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Yarze, Joseph, and Jennifer Beller. "Methimazole-related Hepatotoxicity." American Journal of Gastroenterology 108 (October 2013): S316. http://dx.doi.org/10.14309/00000434-201310001-01060.
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Chattaway, Jeanne M., and Teresa B. Klepser. "Propylthiouracil Versus Methimazole in Treatment of Graves' Disease During Pregnancy." Annals of Pharmacotherapy 41, no. 6 (June 2007): 1018–22. http://dx.doi.org/10.1345/aph.1h535.
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OBJECTIVE: To evaluate the evidence supporting the use of propylthiouracil (PTU) versus methimazole for the treatment of Graves' disease during pregnancy. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1966–March 2007). Identified articles were then reviewed for additional sources. Search terms included hyperthyroidism, Graves' disease, pregnancy, propylthiouracil, and methimazole. STUDY SELECTION AND DATA EXTRACTION: All clinical trials and case reports that were published in English and reported either subjective or objective outcomes were reviewed. DATA SYNTHESIS: Rationale supporting the use of PTU over methimazole in treatment of Graves' disease during pregnancy is limited. Theories suggesting that PTU has less placental transfer to the fetus than methimazole are not supported by current literature. Studies demonstrating a causal relationship between methimazole use during pregnancy and congenital anomalies and/or fetal hypothyroidism do not exist. CONCLUSIONS: The selection of PTU versus methimazole for the treatment of Graves' disease during pregnancy should not be based solely on the following assumptions: that PTU crosses the placenta less than methimazole, that PTU leads to less fetal hypothyroidism, or that exposure to methimazole during pregnancy leads to decreased intellectual function in children. However, due to a possible association between the use of methimazole during pregnancy and fetal anomalies such as aplasia cutis, esophageal atresia, and choanal atresia, methimazole may be a less desirable first-line treatment for Graves' disease in pregnancy than PTU. Therefore, in the absence of a compelling indication for the use of methimazole, PTU should still be considered as the first-line agent in the treatment of Graves' disease during pregnancy. Methimazole should be considered a viable second choice if the patient is intolerant to PTU, has an allergic reaction to PTU, or fails to become euthyroid while receiving PTU. CONCLUSIONES: La selección de PTU versus metimazole en el tratamiento de enfermedad de Graves durante el embarazo no debe ser basada en la siguiente información: 1que PTU cruza la placenta a un menor grado que metimazole, que PTU se asocia con menos hipotiroidismo fetal, ó que la exposición a metimazole durante el embarazo lleva a una disminución en la función intelectual en niños. Sin embargo, debido a una posible asociación entre el uso de metimazole durante el embarazo y anormalidades fetales tales como aplasia cutis, atresia esofageal y atresia choanal, metimazole podría ser una alternativa de primera línea menos deseable para el tratamiento de enfermedad de Graves durante el embarazo que PTU. Por lo tanto, en la ausencia de indicación contundente para el uso de metimazole, PTU debe considerarse el agente de primera línea en el tratamiento de enfermedad de Graves durante el embarazo. Sin embargo, metimazole puede considerarse un agente alterno si el paciente no tolera el PTU, tiene reacción alérgica a PTU o falla en convertir a eutirodeo con PTU. RÉSUMÉ: Il existe peu de justification à l'utilisation du PTU plutôt que du methimazole. Certaines théories suggérant que le PTU traverse moins la barrière placentaire ne sont pas, à l'heure actuelle, supportées par des évidences. Les études démontrant une relation de cause à effet entre le methimazole et des anomalies congénitales et/ou de l'hypothyroïdisme chez le fétus n'existent pas.
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Khine, Le Yu, Dong Won Kim, Omolola Olajide, Chelsey White, Yousef Shweihat, and Henry Driscoll. "Methimazole-Induced Pleural Effusion in the Setting of Graves’ Disease." Case Reports in Endocrinology 2019 (August 4, 2019): 1–4. http://dx.doi.org/10.1155/2019/5748938.
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Methimazole is a thionamide drug that inhibits the synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland. We report a case of methimazole-induced recurrent pleural effusion. A 67-year-old female with recently diagnosed Graves’ disease on methimazole 20mg daily was admitted with dyspnea and new onset atrial fibrillation with rapid ventricular rate. Chest X-ray revealed a unilateral right pleural effusion, which was consistent with a transudate on thoracocentesis. She was managed as a case of congestive heart failure and methimazole dose was increased to 30 mg daily. She was readmitted twice with recurrent right pleural effusion. The fluid revealed an exudative process on repeat thoracocentesis. CT scan of the chest with contrast showed mediastinal lymphadenopathy and a diffuse ground glass process involving the right lower lobe suggestive of pneumonitis. Bronchoalveolar lavage showed neutrophil predominant fluid, and cytology and adenosine deaminase were negative. Patient also had an endobronchial ultrasound guided biopsy of the lymph nodes (EBUS). She was treated empirically with steroids 40 mg for 10 days and the methimazole was also discontinued. The antinuclear antibodies (ANA) came back positive with a speckled pattern; antineutrophil cytoplasmic antibody (c-ANCA) and antimyeloperoxidase were also positive. The effusion resolved but recurred on rechallenge with methimazole. She was referred for urgent thyroidectomy. The patient’s repeat chest X-ray showed complete resolution of the pleural effusion after stopping the methimazole. Few weeks later, repeat ANCA and antimyeloperoxidase antibody were both negative. Our case report highlights the importance of the recognition of a rare side effect of methimazole. Timely diagnosis would ensure that appropriate treatment is given.
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G. N., Vibhashree, Anuradha H. V., and Pramila Kalra. "Methimazole induced lichenoid eruptions: an unusual case." International Journal of Basic & Clinical Pharmacology 6, no. 6 (May 23, 2017): 1535. http://dx.doi.org/10.18203/2319-2003.ijbcp20172256.
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This is a case report of a 31-year-old male presented to the Endocrinology outpatient department of our hospital with hyperthyroidism and was prescribed tablet methimazole 30mg once daily and tablet propranolol 40mg once daily. After 3 months, the patient complained of violaceous papular lesions on both the extensor aspect of the arms and legs. Physical examination was remarkable for acute onset, raised, itchy, violaceous papular lesions over the defined areas. The drug methimazole was suspected to cause lichenoid drug eruptions and was withdrawn. This case illustrates methimazole otherwise an efficacious and widely used anti thyroid drug is an agent capable of inducing lichenoid eruptions. However in future the monitoring of methimazole is essential for such adverse reaction.
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Dudka, Jaroslaw, Franciszek Burdan, Agnieszka Korga, Magdalena Iwan, Barbara Madej-Czerwonka, Monika Cendrowska-Pinkosz, Agnieszka Korobowicz-Markiewicz, Barbara Jodlowska-Jedrych, and Wlodzimierz Matysiak. "Intensification of Doxorubicin-Related Oxidative Stress in the Heart by Hypothyroidism Is Not Related to the Expression of Cytochrome P450 NADPH-Reductase and Inducible Nitric Oxide Synthase, As Well As Activity of Xanthine Oxidase." Oxidative Medicine and Cellular Longevity 2012 (2012): 1–11. http://dx.doi.org/10.1155/2012/139327.
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Cytochrome P450 NADPH-reductase (P450R), inducible synthase (iNOS) and xanthine oxidase play an important role in the antracycline-related cardiotoxicity. The expression of P450R and iNOS is regulated by triiodothyronine. The aim of this study was to evaluate the effect of methimazole-induced hypothyreosis on oxidative stress secondary to doxorubicin administration. 48 hours after methimazole giving cessation, rats were exposed to doxorubicin (2.0, 5.0 and 15 mg/kg). Blood and heart were collected 4, 48 and 96 h after the drug administration. Animals exposed exclusively to doxorubicin or untreated ones were also assessed. The hypothyreosis (0.025% of methimazole) significantly increased the doxorubicin effect on the cardiac carbonyl group and they may increase the glutathione level. An insignificant effect of methimazole was noticed in case of the cardiac lipid peroxidation product, the amount of DNA oxidative damages, iNOS and xanthine oxidase-enzymes responsible for red-ox activation of doxorubicin. However, the concentration of P450R was affected by a lower dose of methimazole in rats administered with doxorubicin. Since in rats receiving doxorubicin changes in oxidative stress caused by methimazole were not accompanied by elevation of bioreductive enzymes, it may be concluded that these changes in the oxidative stress were not related to the tested enzymes.
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Komoike, Yuta, Masato Matsuoka, and Kenjiro Kosaki. "Potential Teratogenicity of Methimazole: Exposure of Zebrafish Embryos to Methimazole Causes Similar Developmental Anomalies to Human Methimazole Embryopathy." Birth Defects Research Part B: Developmental and Reproductive Toxicology 98, no. 3 (April 29, 2013): 222–29. http://dx.doi.org/10.1002/bdrb.21057.
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Shikha, Deep, Jonathan Harris, Christine Resta, and Patricia Park. "Antineutrophilic Cytoplasmic Antibody Positive Vasculitis Associated with Methimazole Use." Case Reports in Endocrinology 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/530319.
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ANCA-associated vasculitis (AAV) is a rare and potentially life threatening complication associated with antithyroid drug use. It is more commonly reported with propylthiouracil, with fewer cases reported with methimazole use. We present the case of a 55-year-old man with toxic multinodular goiter which was treated with methimazole for 6 months. He developed ANCA positive leukocytoclastic vasculitis with hemorrhagic and necrotic bullous lesions of lower extremities. The vasculitis was initially thought to be secondary to recent cephalosporin use; however, the skin lesions progressed despite stopping the cephalosporin and treatment with steroids, and he developed osteomyelitis. His vasculitis resolved after cessation of methimazole use. This case highlights the importance of careful monitoring for variable manifestations of AAV in patients treated with methimazole.
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Rosario, Pedro Weslley, Gabriela Costa Andrade, and Flavia Coimbra Pontes Maia. "Antineutrophil Cytoplasmic Antibodies in Patients Treated With Methimazole." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A922. http://dx.doi.org/10.1210/jendso/bvab048.1883.
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Abstract Introduction: Antithyroid drugs (ATDs) are widely used for the treatment of hyperthyroidism. Most side effects of these medications are mild and emerge within the first months of treatment. In contrast, antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is a severe adverse event whose occurrence increases with increasing time of treatment. Vasculitis is more frequently associated with propylthiouracil than with methimazole, but the latter has also been related to the occurrence of ANCA and even to clinically manifest vasculitis. Many patients develop ANCA during treatment with methimazole but do not exhibit signs/symptoms of vasculitis. Objective: We previously reported a relatively high frequency (20%) of ANCA in patients exposed to methimazole but none of them exhibited clinical manifestations of vasculitis on that occasion. We continued to follow up these patients with ANCA and report here their evolution after 2 years. Methods: Seventeen patients exposed to methimazole were followed for 2 years after antibodies detection (ANCA). Results: Eight patients had ANCA but had not used methimazole for at least 6 months. During the following 24 months, continuing without ATD, none of the patients developed clinically apparent vasculitis. In the last assessment, five patients no longer had ANCA, while these antibodies persisted in three. Nine patients had ANCA and had been on methimazole for at least 6 months. The medication was not immediately discontinued in these patients when the antibodies were detected. After this detection, treatment with methimazole was continued in these patients for more 3 months (n = 1), 6 months (n = 2), 9 months (n = 1), 12 months (n = 2), 18 months (n = 2), and 24 months (n = 1). During the 2 years of follow-up after the detection of ANCA, none of the 9 patients developed signs/symptoms of vasculitis. In the last assessment, ANCA were negative in two patients who had received methimazole for more 3 and 6 months and who were therefore without receiving the drug for 21 and 18 months, respectively. The other 7 patients remained ANCA positive. Conclusion: Although vasculitis is necessarily associated with the presence of ANCA, the inverse frequency is undefined and appears to be low. Thus, measurement of ANCA would not be recommended in asymptomatic patients during methimazole treatment and immediate discontinuation of this drug, if these antibodies are detected eventually, may not be required. Reference: Antineutrophil cytoplasmic antibodies in patients treated with methimazole: a prospective Brazilian study. Andrade GC, Maia FCP, Mourão GF, Rosario PW, Calsolari MR. Braz J Otorhinolaryngol. 2019; 85:636-41.
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Okuno, Akimasa, Koichi Yano, Fumie Inyaku, Yutaka Suzuki, Nobutaka Sanae, Megumi Kumai, and Yoshihiro Naitoh. "Pharmacokinetics of methimazole in children and adolescents with Graves' disease." Acta Endocrinologica 115, no. 1 (May 1987): 112–18. http://dx.doi.org/10.1530/acta.0.1150112.
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Abstract. Methimazole concentrations in plasma and in the thyroid glands were measured by means of high-performance liquid chromatography. Pharmacokinetics of methimazole were studied after a single oral dose (175 μmol/m2) in nine children and adolescent who were in the thyrotoxic state. Plasma levels of methimazole showed peak concentrations of 4.4 to 12.6 (median 9.2) μmol/l at 0.5 to 4 h after drug administration. Plasma half-life, area under the curve, and distribution volume ranged from 2.73 to 6.04 h, 32.8 to 77.9 μmol · l−1 · h−1, and 0.516 to 0.913 l/kg, respectively. These pharmacokinetic parameters showed a wide variation among the patients, but were quite reproducible in the same subject. Intrathyroidal concentrations of methimazole were measured in another nine subjects including four adolescents and five adults who underwent thyroidectomy. The drug concentrations in the thyroid glands ranged between 3.5 and 23.8 μmol/kg tissue and were far higher than those in the plasma obtained at the time of surgery. In this series of experiments, the dose of the drug varied from 76 to 319 μmol/m2, time after the last dose to surgery from 5 to 24 h, and the mode of drug administration from a single to three divided doses. Among these variable factors, only the daily dose of methimazole corrected by body surface area showed significant correlation with the intrathyroidal concentration, whereas the time after the last dose of the drug and the mode of drug administration did not. Our results revealed that methimazole was concentrated in the thyroid gland and that the intrathyroidal concentrations were maintained for 16 to 24 h in spite of a short plasma half-life. It is suggested that a single daily dose of methimazole is adequate for the treatment of Graves' disease in children and adolescents.
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Zhao, Lina, Xianyu Zhang, and Chunhai Zhang. "Methimazole Inhibits the Expression of GFAP and the Migration of Astrocyte in Scratched Wound Model In Vitro." Mediators of Inflammation 2020 (April 13, 2020): 1–7. http://dx.doi.org/10.1155/2020/4027470.
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Astrocytes respond to central nervous system (CNS) insults with varieties of changes, such as cellular hypertrophy, migration, proliferation, scar formation, and upregulation of glial fibrillary acidic protein (GFAP) expression. While scar formation plays a very important role in wound healing and prevents further bleeding by forming a physical barrier, it is also one of key features of CNS injury, resulting in glial scar formation (astrogliosis), which is closely related to treatment resistant epilepsy, chronic pain, and other devastating diseases. Therefore, slowing the astrocytic activation process may give a time window of axonal growth after the CNS injury. However, the underlying mechanism of astrocytic activation remains unclear, and there is no effective therapeutic strategy to attenuate the activation process. Here, we found that methimazole could effectively inhibit the GFAP expression in physiological and pathological conditions. Moreover, we scratched primary cultures of cerebral cortical astrocytes with and without methimazole pretreatment and investigated whether methimazole could slow the healing process in these cultures. We found that methimazole could inhibit the GFAP protein expression in scratched astrocytes and prolong the latency of wound healing in cultures. We also measured the phosphorylation of extracellular signal-regulated kinase (ERK) in these cultures and found that methimazole could significantly inhibit the scratch-induced GFAP upregulation. For the first time, our study demonstrated that methimazole might be a possible compound that could inhibit the astrocytic activation following CNS injury by reducing the ERK phosphorylation in astrocytes.
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Angelis, Dimitrios, Rita Ann Kubicky, and Alan B. Zubrow. "Methimazole Associated Neutropenia in a Preterm Neonate Treated for Hyperthyroidism." Case Reports in Endocrinology 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/680191.
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Maternal Graves’ disease is relatively uncommon with an estimated incidence of 0.4%–1% of all pregnancies, but only 1–5% of newborns delivered to mothers with Graves’ disease develop overt clinical signs and symptoms of hyperthyroidism. Here, we describe a case of a 1380-gram female neonate who was born at 30-week gestation to a mother with Graves’ disease. Our patient presented with hyperthyroidism followed by transient hypothyroidism requiring treatment with levothyroxine. While hyperthyroid, she was treated with methimazole, iodine, and a beta-blocker. 20 days after the initiation of methimazole, she developed neutropenia. The neutrophil counts started to improve immediately after the initiation of the weaning of methimazole. To the best of our knowledge, this is the first case reported in the literature of methimazole induced neutropenia in a preterm infant being treated for neonatal Graves’ disease.
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Chabrolle, J. P., H. Bruel, E. El Khoury, J. Poinsot, P. Amusini, A. Benouada, and J. P. Marie. "Methimazole et atrésie choanale." Archives de Pédiatrie 10, no. 5 (May 2003): 463–64. http://dx.doi.org/10.1016/s0929-693x(03)00097-6.
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Bishara, Jihad, Shlomo Dux, and Silvio Pitlik. "Methimazole-Induced Aplastic Anemia." Annals of Pharmacotherapy 30, no. 6 (June 1996): 684. http://dx.doi.org/10.1177/106002809603000622.
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Mikhail, Nasser E. "Methimazole-induced Cholestatic Jaundice." Southern Medical Journal 97, no. 2 (February 2004): 178–82. http://dx.doi.org/10.1097/01.smj.0000054690.98272.b1.
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Varisli, Behcet, Sinan Yildirim, Hatice Karacam, and Sehnaz Paker. "Methimazole-Induced Febrile Neutropenia." Journal of Emergency Medicine Case Reports 9, no. 1 (February 5, 2018): 13–15. http://dx.doi.org/10.5152/jemcr.2018.1851.
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Siriwardana, Amal I., Ian R. Crossley, Angel A. J. Torriero, Iko M. Burgar, Noel F. Dunlop, Alan M. Bond, Glen B. Deacon, and Douglas R. MacFarlane. "Methimazole-Based Ionic Liquids." Journal of Organic Chemistry 73, no. 12 (June 2008): 4676–79. http://dx.doi.org/10.1021/jo702511v.
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Arrigo, T., PM Cutroneo, M. Vaccaro, D. Impollonia, V. Squadrito, A. Mecchio, C. Salpietro, and D. Altavilla. "Lateralized exanthem mimicking figurate inflammatory dermatosis of infancy after methimazole therapy." International Journal of Immunopathology and Pharmacology 29, no. 4 (July 7, 2016): 707–11. http://dx.doi.org/10.1177/0394632016652412.
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We reported a case of an 11-year-old girl admitted to our hospital for goiter, tachycardia, sweating, and visible and palpable thyroid. Thyroid function tests revealed a low thyrotropin level (<0.004 mIU/L) and elevated free thyroxine level (3.4 ng/ dL) diagnosed with Graves’ disease and treated with methimazole. This anti-thyroid drug is recommended as first-line treatment in children with Graves’ disease because it produces minor adverse effects with respect to propylthiouracil. She developed a lateralized exanthem mimicking figurate inflammatory dermatosis of infancy after methimazole therapy. The symptoms resolved after discontinuation of methimazole and treatment with an antihistamine and a corticosteroid. Furthermore, the treatment was changed to propylthiouracil without any adverse effects. According to current literature this is the first case of cutaneous figurate erythema related to methimazole, different from other well-known reactions such as skin eruption or urticaria.
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Andrawis, A., and V. Kahn. "Effect of methimazole on the activity of mushroom tyrosinase." Biochemical Journal 235, no. 1 (April 1, 1986): 91–96. http://dx.doi.org/10.1042/bj2350091.
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Methimazole (1-methyl-2-mercaptoimidazole) inhibits both the mono- and the o-dihydroxyphenolase activities of mushroom tyrosinase when assayed spectrophotometrically. With DL-3,4-dihydroxyphenylalanine as substrate, the inhibition was found to be a mixed-type one with Ki 4.6 × 10(-6) M. We found that methimazole can interact with the oxidation products of o-dihydroxyphenols, probably with o-quinones, to form a conjugate. The conjugate formed between methimazole and o-benzoquinone was separated by chromatography on Sephadex G-10 and was characterized by an absorption maximum at 248-260 nm. Our data suggest that methimazole inhibits mushroom tyrosinase activity in two ways: by conjugating with o-quinones, thereby causing an apparent inhibition in pigmented product formation as judged by the spectrophotometric assay; and by chelating copper at the active site of the enzyme, as judged by assaying the release of 3HHO from L-[3,5-3H]tyrosine.
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Amara, Ibtissem Ben, Ahmed Hakim, Afef Troudi, Nejla Soudani, Fatma Ayadi Makni, Khaled Mounir Zeghal, and Najiba Zeghal. "Protective effects of selenium on methimazole-induced anemia and oxidative stress in adult rats and their offspring." Human & Experimental Toxicology 30, no. 10 (December 20, 2010): 1549–60. http://dx.doi.org/10.1177/0960327110392403.
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The present study investigates the potential ability of selenium, considered as an antioxidant with pharmacological property to alleviate oxidative stress and hematological parameter disorders induced by methimazole, an antithyroid drug. Pregnant Wistar rats were randomly divided into four groups of six each: group I served as negative control and received a standard diet; group II received 250 mg/L of methimazole in drinking water and a standard diet; group III received both methimazole (250 mg/L, orally) and selenium (0.5 mg/kg of diet) supplemented to the standard diet; group IV served as positive control and received a supplement of selenium in the diet (0.5 mg/kg of diet) as sodium selenite (Na2SeO3). Treatment was started from the 14th day of pregnancy until day 14 after delivery. Methimazole reduced the number of red blood cells, hemoglobin concentration and hematocrit in mothers and their pups. Besides, plasma iron, vitamins B9, B12, C and E levels were reduced. Lipid peroxidation increased, objectified by high malondialdehyde levels and lactate dehydrogenase activity in plasma, while glutathione, glutathione peroxidase, superoxide dismutase and catalase activities showed a significant decline. Co-administration of selenium through diet improved all the parameters cited above. It can be concluded that the administration of selenium alleviates methimazole-induced toxicity, thus demonstrating its antioxidant efficacy.
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Guignon, Anne-Maëlle, Michel P. Mallaret, and Pierre Simon Jouk. "Carbimazole-Related Gastroschisis." Annals of Pharmacotherapy 37, no. 6 (June 2003): 829–31. http://dx.doi.org/10.1345/aph.1c368.
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OBJECTIVE: To report a case of gastroschisis in a newborn secondary to carbimazole exposure in utero. CASE SUMMARY: A 25-year-old white woman was treated for Graves disease with carbimazole throughout pregnancy. A boy was born prematurely by vaginal delivery, with a gastroschisis without associated malformative syndrome. Death occurred in the 25th hour of life after surgical repair. DISCUSSION: Carbimazole is completely metabolized to methimazole after absorption. Carbimazole or methimazole intake during pregnancy has been associated with an increased incidence of scalp aplasia. Abdominal wall defects secondary to carbimazole or methimazole exposure in utero seem to be a rare occurrence. However, other cases of abdominal wall defects have been reported in 4 newborns, 2 of them associated with scalp aplasia. An objective causality assessment revealed that the relationship between the gastroschisis and the exposure to carbimazole in utero was possible. CONCLUSIONS: It is important to emphasize the possible risk of abdominal wall defects in newborns to pregnant women taking carbimazole or methimazole.
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Hammami, Safa, Kathryn Graham Schuff, and Barbara Diane Hettinger. "Profound Hypothyroidism 21 Days After Methimazole Initiation in a Patient With Graves’s Disease and Liver Cirrhosis." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A949—A950. http://dx.doi.org/10.1210/jendso/bvab048.1940.
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Abstract Introduction: Methimazole is the first line treatment of nonpregnant Grave’s disease (GD) patients with Grave’s ophthalmopathy. It usually results in euthyroidism within 4 to 12 weeks, and it is recommended to check FT4 every 4 to 6 weeks after initiation of therapy. We report a patient with GD who developed profound hypothyroidism 21 days after starting methimazole. Clinical Case: 51-year-old male with decompensated EtOH/NASH liver cirrhosis, Gilbert’s syndrome, and GD presented with severe hypothyroidism 21 days after initiating methimazole treatment. He initially presented to the emergency department (ED) with atrial fibrillation with a HR of 140 and found to have bilateral exophthalmos and lid lag. Labs: TSH <0.01 uIU/L (normal range (nl) 0.27-4.20), FT4 2.6 ng/dl (nl 0.7-1.7), TT4 6.2 ug/dl (nl 4.5-12), TT3 125 ng/dl (nl 71-180), TBG 14 ug/ml (nl 13-39), TSI 344 IU/l (nl 0-0.5), AST 55 IU/L (nl 14-44), ALT 27 IU/L (nl 9-57), Alk Phosphatase 497 IU/L (nl 45-129), Tbili 7.1 mg/dl (nl 0.2-.1), and albumin 2.1 g/dl (nl 3.4-5). He was started on methimazole 40 mg daily and propranolol 20 mg BID. Three days later, FT4 decreased to 1.3 ng/dl, so methimazole was decreased to 20 mg day. Ten days later, FT4 was 0.2 ng/dl and methimazole was reduced further to 10 mg daily. Eight days later, he presented to the ED with severe lethargy and found to have HR of 38 and oral temperature (T) of 94. TSH was 3.49 uIU/L and FT4 <0.1 ng/dl. Sixteen hours after 200 mcg IV levothyroxine, he had normal mental status, HR of 49, and T of 97.9. FT4 increased to 0.5 ng/dl within 48 hours of thyroxine initiation. Urine drug screen was only positive for tetrahydrocannabinol and other work up for severe lethargy and hypothermia was unremarkable. He was discharged on 100 mcg of PO levothyroxine. Conclusion: Only 21 days after starting methimazole, the patient developed severe lethargy associated with hypothermia, bradycardia, and undetectable FT4, with no alternative etiology and prompt response to IV levothyroxine, consistent with profound hypothyroidism. Although the half-life of T4 is shortened in hyperthyroidism, the particularly fast and profound effect of methimazole in this patient was unusual and likely due to a limited extra-thyroidal pool of thyroxine caused by low TBG level. As cirrhosis is usually associated with increased TBG level, he may have a contributing congenital etiology. Reduced levels of other T4 binding proteins, albumin and pre-albumin may also have contributed. Although methimazole clearance can be decreased in liver impairment, no dose adjustment is generally recommended, and even this would not have explained the observed rapid decrease in FT4 level. Methimazole should be used with caution and FT4 should be checked early and more frequently when treating hyperthyroid patients with liver disease and possible alteration in thyroid binding proteins.
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Isman, CA, BC Yegen, and I. Alican. "Methimazole-induced hypothyroidism in rats ameliorates oxidative injury in experimental colitis." Journal of Endocrinology 177, no. 3 (June 1, 2003): 471–76. http://dx.doi.org/10.1677/joe.0.1770471.
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Depression of metabolism by hypothyroidism decreases oxidant production and thus protects tIssues against oxidant damage. Moreover, it is well-known that abnormal gut motility is a common manifestation in hypo/hyperthyroidism. In this study, we aimed to investigate the putative beneficial effects of methimazole on oxidative injury and dysmotility in a rat colitis model. Methimazole (0.04%) was administered in drinking water starting 15 days prior to induction of colitis. Colitis was induced by intracolonic administration of trinitrobenzene sulfonic acid (30 mg/ml; 0.8 ml) in ethanol. Six days after the induction of colitis, the fecal output was measured and used as an index for colonic motility. All rats were decapitated on the seventh day. The distal colon was weighed and the mucosal lesions were scored. Colonic lipid peroxidation (LP) and glutathione (GSH) measurements were performed. The macroscopic score, the colonic wet weight and LP values of the euthyroid colitis group were found to be higher than those of the control group (P<0.05-0.001). All these parameters were reduced in the methimazole-treated colitis group (P<0.01-0.001). The decrease in colonic GSH levels in the colitis group was completely abolished in the methimazole-treated colitis rats (P<0.01). Induction of colitis increased the average fecal output compared with the control group (P<0.05) and methimazole in the colitis group exaggerated the fecal output (P<0.001). In conclusion, methimazole reduces colonic oxidative injury probably due to hypometabolism, which is associated with a decrease in the production of reactive oxygen intermediates and an increase in the response of antioxidant systems.
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Bayramoğlu, Elvan, Selin Elmaogulları, Elif Sagsak, and Zehra Aycan. "Evaluation of long-term follow-up and methimazole therapy outcomes of pediatric Graves’ disease: a single-center experience." Journal of Pediatric Endocrinology and Metabolism 32, no. 4 (April 24, 2019): 341–46. http://dx.doi.org/10.1515/jpem-2018-0495.
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Abstract Background The management options for Graves’ disease in children are limited and there is controversy regarding optimal treatment. Remission rate with anti-thyroid drug (ATD) treatment in children is said to be lower than in adults. Definitive treatments are effective, but they often result in permanent hypothyroidism. The objective of this study was to investigate the outcome of methimazole treatment, identify significant predictors of a remission and evaluate the adverse effects of methimazole in a pediatric population of GD patients. Methods Medical records of the patients who had been diagnosed with Graves’ disease were screened retrospectively. Diagnostic criteria included elevated free thyroxine (fT4) and total triiodothyronine (T3), suppressed thyroid-stimulating hormone (TSH) and either positive thyroid-stimulating immunoglobulin (TSI) or thyroid receptor antibodies (TRABs) or clinical signs suggestive of Graves’ disease, for example, exophthalmos. Remission was defined as maintenance of euthyroidism for more than 12 months after discontinuing methimazole treatment. Results Of the 48 patients, provisional remission was achieved in 21 patients. Of the 21 patients, 14 experienced a relapse (66.6%). Remission was achieved in seven (24.1%) of 29 patients who received methimazole treatment for more than 2 years. In patients who achieved long-term remission, the male sex ratio and fT4 levels at diagnosis were significantly lower than the relapsed and non-remission groups, whereas the free triiodothyronine (fT3)/fT4 ratio and duration of methimazole treatment were significantly higher than the relapse group. Conclusions Long-term methimazole treatment in pediatric Graves’ disease would be appropriate. High fT4 levels at the time of diagnosis and male sex were associated with a risk of relapse.
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Ribeiro, Carla de Oliveira, Paula Ferrazzi Magrin, Enoí Aparecida Guedes Vilar, Sandra Maria Barbosa Durães, and Rogério Ribeiro Estrella. "Cutaneous leukocytoclastic vasculitis in the presence of methimazole therapy." Anais Brasileiros de Dermatologia 88, no. 2 (April 2013): 283–86. http://dx.doi.org/10.1590/s0365-05962013000200021.
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Treatment with antithyroid drugs may be accompanied by side effects. We present a patient diagnosed with Grave's Disease who developed extensive vasculitis in the lower limbs during methimazole use. After suspension of the methimazole and the introduction of prednisone in immunesupressor doses the cutaneous lesions started to involute.
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Mittal, Ashima, and Murray B. Gordon. "Transdermal Absorption of Methimazole- a Cat’s Tale." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A969. http://dx.doi.org/10.1210/jendso/bvab048.1980.
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Abstract Introduction: In modern civilization different kinds of animals live with us as pets. These pets have different diseases and are on medications. Close contact with animals can cause medication adverse reactions or may worsen pre-existing conditions in humans. Here we present an interesting case of hypothyroidism worsened by transdermal absorption of methimazole administered for feline hyperthyroidism. Case History: 66-year-old Caucasian female with past medical history of postoperative hypothyroidism s/p total thyroidectomy secondary to multinodular goiter due to Hashimoto’s thyroiditis with a 0.2 cm papillofollicular microcarcinoma and 0.7 cm follicular adenoma presented for follow up. She complained of weight gain, lethargy and dry skin for the past 4 months. She was on a stable dose of levothyroxine 112 mcg daily for the past year. She took her pill correctly and did not miss any doses. Her other medical problems were impaired fasting glucose, osteopenia and B12 deficiency. Her repeat thyroid function tests showed TSH 11.2 mc IU/ l (0.4 -4) (TSH - 0.538 mc IU/ L 6 months back), T4 - 6.8 mcg/ dl (4.5 - 12) (T4 8.9 6 months back). She had a measurable serum thyroglobulin of 0.4 ng/ml with antithyroglobulin antibody 11 IU/ml (<115) consistent with some residual thyroid tissue despite her history of a “total thyroidectomy”. Due to recent worsening of her symptoms with elevated TSH on background of previous stable levothyroxine requirement, further detailed history was taken. She reported that her cat was suffering from hyperthyroidism, treated with methimazole 10 mg daily. The patient used to cut the pill in half with bare hands and fed it to her pet. She also used to handle wet methimazole that her cat coughed up. Her levothyroxine dose was continued at 112 mcg daily. The patient was advised to use gloves before feeding and wash her hands after feeding her cat. Her symptoms resolved after she took precautions and TSH normalized to 1.170 mc IU/ l with T4 7.6 two months later. Conclusion: Absorption of methimazole by transdermal administration has been shown in cats1. A study by Kasraee et al showed safety of a 5% topical methimazole application for treatment of post inflammatory hyperpigmentation in humans with no change in thyroid function tests2. Our case contradicts this study and indicates that methimazole might be absorbed transdermally in humans. To conclude, more studies are needed to study the effect of transdermal administration of methimazole in humans. References: 1. Hill KE, Mills PC, Jones BR et.al. Percutaneous absorption of methimazole: an in vitro study of the absorption pharmacokinetics for two different vehicles. J Vet Pharmacol Ther. 2015;38(6):581-589. PMID: 25683868 2. Kasraee B et al. Safety of topical methimazole for the treatment of melasma. Transdermal absorption, the effect on thyroid function and cutaneous adverse effects. Skin Pharmacol Physiol. 2008;21(6):300-305. PMID: 18667842
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Hill, Anthony F., and Matthew K. Smith. "Dihydrobis(methimazolyl)borate and methimazolyl complexes of titanium." Dalton Trans., no. 1 (2006): 28–30. http://dx.doi.org/10.1039/b513251g.
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Leonhardt, U., E. Gerdes, U. Ritzel, G. Schafer, W. Becker, and G. Ramadori. "Immunoreactive leptin and leptin mRNA expression are increased in rat hypo- but not hyperthyroidism." Journal of Endocrinology 163, no. 1 (October 1, 1999): 115–21. http://dx.doi.org/10.1677/joe.0.1630107.
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In this study, plasma leptin concentrations were measured in rats artificially rendered hyper- or hypothyroid by administration of thyroxine or TRH, by administration of methimazole, or by thyroidectomy. Compared with those in untreated controls, leptin immunoreactivity was not affected in the hyperthyroid state, but was significantly increased in hypothyroid animals. Methimazole administration for longer time periods caused a stepwise increase in plasma leptin immunoreactivity. Greatest leptin concentrations were seen after 28 days of methimazole. Seven days after withdrawal of the methimazole, leptin concentrations no longer differed from those observed in control animals. In hypothyroid animals, expression of leptin mRNA was increased in both retroperitoneal and epididymal adipose tissue, whereas no difference was seen for subcutaneous or mesenteric fat. Incubation of rat leptin with plasma of eu- or hypothyroid rats and subsequent HPLC analysis of leptin plasma peaks gave no indication of an altered hormone stability. We conclude that, in hypothyroid rats, leptin concentrations may be increased as a result of stimulated leptin synthesis in retroperitoneal and epididymal adipose tissue.
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Kuo, Shi-Wen, Wen-Sheng Huang, Chan-An Hu, Wen-Kuei Liao, Tsi-Chiang Fung, and Sing-Yung Wu. "Effect of thyroxine administration on serum thyrotropin receptor antibody and thyroglobulin levels in patients with Graves' hyperthyroidism during antithyroid drug therapy." European Journal of Endocrinology 131, no. 2 (August 1994): 125–30. http://dx.doi.org/10.1530/eje.0.1310125.
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Kuo SW, Huang W-S, Hu C-A, Liao W-K, Fung T-C, Wu S-Y. Effect of thyroxine administration on serum thyrotropin receptor antibody and thyroglobulin levels in patients with Graves' hyperthyroidism during antithyroid drug therapy. Eur J Endocrinol 1994;131:125–30. ISSN 0804–4643 Graves' hyperthyroidism is due primarily to overproduction of antibodies to thyrotropin receptors (TR-ab), which stimulate the thyroid gland and cause hyperthyroidism. Antibody production during antithyroid drug therapy is an important determinant of the course of the disease. We therefore observed the changes of serum TR-ab, thyroglobulin (Tg) and thyroid hormone levels in response to administration of l-thyroxine (T4) in Graves' hyperthyroid patients during antithyroid drug therapy. Serum levels of TR-ab, Tg and other thyroid hormones were measured by radioimmunoassay (RIA) during either methimazole treatment alone or in combination with thyroxine in 60 Graves' hyperthyroid patients. The patients initially were treated with 30 mg of methimozole daily for 3 months, which was then reduced to 15 mg daily for the following 3 months. All patients were euthyroid 6 months after the start of antithyroid therapy and the TR-ab level decreased from 61 ± 11% (±sd) to 28 ± 7% (p < 0.01). Patients then were divided into three groups: group A (N = 25), whose TR-ab level was 10% or more (the cut-off value for positivity), received 0.1 mg of T4 and 10 mg of methimazole daily for 6 months; group B (N = 15), whose TR-ab level also was 10% or more and was age- and thyroid function-matched with group A, received only 10 mg of methimazole daily for 6 months; group C (N = 20), with a TR-ab level of less than 10%, received 10 mg of methimazole alone daily for 6 months. In the T4-treated group (group A), the mean serum T4 level increased from 66 ± 21 to 117 ± 30 nmol/l (p < 0.05) and the TR-ab and Tg concentrations decreased from 38 ± 11 to 10 ± 5% (p < 0.01) and 135 ± 25 to 45 ± 12 μg/l (p < 0.01), respectively, after 6 months of combination therapy. In the non-T4-treated groups (groups B and C), the mean serum T4, TR-ab and Tg levels did not change significantly (p > 0.05). Serum TR-ab levels at the end of the combination therapy (group A) were significantly lower than with methimazole alone (27 ± 11%, p < 0.05). Serum TR-ab levels correlated positively with the serum Tg concentrations and ultrasonogram-measured thyroid volume in untreated (r = 0.281, p < 0.05 and r = 0.485, p < 0.001, respectively) and treated (r = 0.288, p < 0.05 and r = 0.480, p < 0.001, respectively) Graves' hyperthyroid patients after the first 6 months of methimazole therapy. A positive correlation was found between thyroid volume and serum Tg concentration before (r = 0.31, p < 0.01) and after (r = 0.450, p < 0.001) the first 6 months of methimazole therapy. However, the serum levels of thyrotropin were not correlated with those of TR-ab and Tg (p > 0.05) after methimazole therapy. In summary, the present study demonstrated a greater fall in serum TR-ab and Tg levels in patients with Graves' disease treated with combined methimazole and T4 than with methimazole alone. Sing-Yung Wu, Station 151, Department of Nuclear Medicine and Medical Services, VA Medical Center, Long Beach, CA 90822, USA
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ROTI, E., G. ROBUSCHI, E. GARDINI, M. MONTERMINI, M. SALVI, A. MANFREDI, A. GNUDI, and L. E. BRAVERMAN. "COMPARISON OF METHIMAZOLE, METHIMAZOLE AND SODIUM IPODATE, AND METHIMAZOLE AND SATURATED SOLUTION OF POTASSIUM IODIDE IN THE EARLY TREATMENT OF HYPERTHYROID GRAVES’DISEASE." Clinical Endocrinology 28, no. 3 (March 1988): 305–14. http://dx.doi.org/10.1111/j.1365-2265.1988.tb01217.x.
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Azmat, Umal, David Liebner, Amy Joehlin-Price, Amit Agrawal, and Fadi Nabhan. "Treatment of Ipilimumab Induced Graves’ Disease in a Patient with Metastatic Melanoma." Case Reports in Endocrinology 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/2087525.
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Objective. Thyroid disease has been reported among the endocrinopathies that can occur after treatment with ipilimumab. Graves’ disease, however, has been rarely reported with this medication. Here we report a case of Graves’ disease diagnosed after initiation of ipilimumab in a patient with melanoma.Methods. We present the clinical presentation and management course of this patient followed by a related literature review.Results. A 67-year-old male with metastatic melanoma was started on ipilimumab. He developed hyperthyroidism after two doses of ipilimumab. The cause of hyperthyroidism was determined to be Graves’ disease. Ipilimumab was held and the patient was started on methimazole with return to euthyroid status. Ipilimumab was resumed and the patient continued methimazole during the course of ipilimumab therapy, with controlled hyperthyroidism. Restaging studies following four cycles of ipilimumab showed complete response in the lungs, with residual melanoma in the neck. The patient then underwent total thyroidectomy and left neck dissection as a definitive treatment for both hyperthyroidism and residual melanoma.Conclusion. Graves’ disease can develop after starting ipilimumab and methimazole can be an effective treatment. For patients whose hyperthyroidism is well-controlled on methimazole, ipilimumab may be resumed with close monitoring.