Clinical manifestations and early effectiveness of methimazole in patients with graves’ hyperthyroidism-related severe hepatic dysfunction

Abstract

Background

Graves’ hyperthyroidism (GH) is often accompanied by mild to moderate liver injury, but severe hepatic dysfunction (SHD) is relatively rare. Whether patients with GH-related SHD can be treated with methimazole (MMI) remains controversial. This study aimed to determine the clinical characteristics and to evaluate the role of low-dose MMI for such patients.

Methods

33 patients with GH-related SHD were selected for this retrospective study in the Fifth Medical Center of Chinese PLA General Hospital from January 2017 to July 2022. The clinical manifestations, therapeutic responses, and effectiveness of MMI were evaluated.

Results

Systemic jaundice (100.0%), yellow urine (100.0%), fatigue (87.9%), and goiter (66.7%) were the main symptoms. Total bilirubin (TBIL) had no linear correlation with free triiodothyronine (FT₃) (r = −0.023, p = .899), free thyroxine (FT₄) (r = 0.111, p = .540), T₃ (r = −0.144, p = .425), and T₄ (r = 0.037, p = .837). On the 14th day after admission, FT₃, FT₄, T₃, T₄, TBIL, direct bilirubin (DBIL), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), and international normalized ratio (INR) decreased compared with the baseline (p < .05). The decrease rates of FT₃, FT₄, T₃, T₄, TBIL, and DBIL in the MMI group were higher than those in the non-MMI group (p < .05). The improvement rate of the MMI group (77.8%) was higher than that of the non-MMI group (9.5%, p = .001). MMI treatment is an independent predictor affecting the early improvement of patients (OR = 0.022, p = .010).

Conclusions

The main clinical manifestations of patients with GH-related SHD were symptoms related to liver disease. Low-dose MMI was safe and effective for them.

Keywords:

• Graves’ hyperthyroidism
• severe hepatic dysfunction
• clinical manifestation
• effectiveness
• methimazole

Authors contributions

CL, JHH, and HBS participated in the treatment of these patients and designed the study. CL, KLW, JHH, and HBS collected and analyzed the data of patients. CL wrote the first draft with assistance from KLW, JHH and HBS. JHH and HBS edited the final manuscript. All authors read and approved the final manuscript. All authors confirm that the manuscript has not been published before.

Ethical approval

This study was in accordance with the Helsinki Declaration and approved by the Ethics Committee of the Fifth Medical Center of Chinese PLA General Hospital. Informed consent was waived because of the retrospective nature of this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Key R&D Program of China (2021YFC2301801) and the Education and Teaching Research Project of Peking University Health Science Center (2022YB49).