Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism
We report here a unique case of methimazole (MMI)-induced pancreatitis. To our knowledge, this is the sixth case reported in the literature and the first diagnosed in a patient with toxic multinodular goiter. A 51-year-old Caucasian female with a history of benign multinodular goiter and subclinical...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2015-06-01
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| Series: | Journal of Investigative Medicine High Impact Case Reports |
| Online Access: | https://doi.org/10.1177/2324709615592229 |
| _version_ | 1818476585652584448 |
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| author | Katrina Agito MD Andrea Manni MD |
| author_facet | Katrina Agito MD Andrea Manni MD |
| author_sort | Katrina Agito MD |
| collection | DOAJ |
| description | We report here a unique case of methimazole (MMI)-induced pancreatitis. To our knowledge, this is the sixth case reported in the literature and the first diagnosed in a patient with toxic multinodular goiter. A 51-year-old Caucasian female with a history of benign multinodular goiter and subclinical hyperthyroidism was started on MMI 10 mg orally daily. Three weeks later, she developed sharp epigastric pain, diarrhea, lack of appetite, and fever. Her lipase was elevated 5 times the upper limit of normal, consistent with acute pancreatitis. There was no history of hypertriglyceridemia, or alcohol abuse. Abdominal computed tomography was consistent with acute uncomplicated pancreatitis, without evidence of gallstones or tumors. MMI was discontinued, and her hyperthyroid symptoms were managed with propranolol. Her acute episode of pancreatitis quickly resolved clinically and biochemically. One year later, she redeveloped mild clinical symptoms of hyperthyroidism with biochemical evidence of subclinical hyperthyroidism. MMI 10 mg orally daily was restarted. Five days later, she experienced progressive abdominal discomfort. Her lipase was elevated 12 times the upper limit of normal, and the abdominal computed tomography was again compatible with acute uncomplicated pancreatitis. MMI was again discontinued, which was followed by rapid resolution of her pancreatitis. The patient is currently considering undergoing definitive therapy with radioactive iodine ablation. Our case as well as previous case reports in the literature should raise awareness about the possibility of pancreatitis in subjects treated with MMI in the presence of suggestive symptoms. If the diagnosis is confirmed by elevated pancreatic enzymes, the drug should be discontinued. |
| first_indexed | 2024-12-10T09:27:41Z |
| format | Article |
| id | doaj.art-150e4d7d5a0549f8b009f973eff04180 |
| institution | Directory Open Access Journal |
| issn | 2324-7096 |
| language | English |
| last_indexed | 2024-12-10T09:27:41Z |
| publishDate | 2015-06-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Investigative Medicine High Impact Case Reports |
| spelling | doaj.art-150e4d7d5a0549f8b009f973eff041802022-12-22T01:54:28ZengSAGE PublishingJournal of Investigative Medicine High Impact Case Reports2324-70962015-06-01310.1177/232470961559222910.1177_2324709615592229Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical HyperthyroidismKatrina Agito MD0Andrea Manni MD1Penn State University/Milton S. Hershey Medical Center, Hershey, PA, USAPenn State University/Milton S. Hershey Medical Center, Hershey, PA, USAWe report here a unique case of methimazole (MMI)-induced pancreatitis. To our knowledge, this is the sixth case reported in the literature and the first diagnosed in a patient with toxic multinodular goiter. A 51-year-old Caucasian female with a history of benign multinodular goiter and subclinical hyperthyroidism was started on MMI 10 mg orally daily. Three weeks later, she developed sharp epigastric pain, diarrhea, lack of appetite, and fever. Her lipase was elevated 5 times the upper limit of normal, consistent with acute pancreatitis. There was no history of hypertriglyceridemia, or alcohol abuse. Abdominal computed tomography was consistent with acute uncomplicated pancreatitis, without evidence of gallstones or tumors. MMI was discontinued, and her hyperthyroid symptoms were managed with propranolol. Her acute episode of pancreatitis quickly resolved clinically and biochemically. One year later, she redeveloped mild clinical symptoms of hyperthyroidism with biochemical evidence of subclinical hyperthyroidism. MMI 10 mg orally daily was restarted. Five days later, she experienced progressive abdominal discomfort. Her lipase was elevated 12 times the upper limit of normal, and the abdominal computed tomography was again compatible with acute uncomplicated pancreatitis. MMI was again discontinued, which was followed by rapid resolution of her pancreatitis. The patient is currently considering undergoing definitive therapy with radioactive iodine ablation. Our case as well as previous case reports in the literature should raise awareness about the possibility of pancreatitis in subjects treated with MMI in the presence of suggestive symptoms. If the diagnosis is confirmed by elevated pancreatic enzymes, the drug should be discontinued.https://doi.org/10.1177/2324709615592229 |
| spellingShingle | Katrina Agito MD Andrea Manni MD Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism Journal of Investigative Medicine High Impact Case Reports |
| title | Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism |
| title_full | Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism |
| title_fullStr | Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism |
| title_full_unstemmed | Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism |
| title_short | Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism |
| title_sort | acute pancreatitis induced by methimazole in a patient with subclinical hyperthyroidism |
| url | https://doi.org/10.1177/2324709615592229 |
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