SAT-599 Propylthiouracil-Induced Anaphylaxis with Subsequent Tolerance of Methimazole
Notice bibliographique
Résumé
Background: Although the thionamides have been associated with adverse effects such as cutaneous reactions, hepatotoxicity, and agranulocytosis, anaphylaxis is rarely reported (1). We describe the case of a patient with Graves’ disease, who developed anaphylaxis after treatment with propylthiouracil (PTU), and who subsequently tolerated methimazole. Clinical Case: A 38-year-old woman presented to the emergency department with worsening palpitations, weight loss, and tremor. She was found to be severely thyrotoxic with TSH < 0.01 (normal 0.27-4.20 mU/L), free T4 > 100 (normal 12.0-22.0 pmol/L), free T3 44.2 (normal 3.1-6.9 pmol/L), and TSH receptor antibody 4.0 (normal < 1.8 IU/L). Past medical history was significant for beta-thalassemia trait and two previous early pregnancy losses. Treatment options were reviewed, and initial therapy with an antithyroid medication was recommended. The patient was started on propranolol 20 mg PRN and PTU 100 mg PO TID, chosen because she hoped to become pregnant once euthyroid. She was discharged home with outpatient endocrinology follow-up. After the first dose of PTU, she developed acute onset tongue, lip, and facial swelling, with full-body urticaria. She immediately returned to the emergency department, where she became hypotensive and sustained a syncopal episode. She was treated for anaphylaxis with epinephrine, prednisone, diphenhydramine, and ranitidine. The case was reviewed with specialists from allergy, nuclear medicine, and surgery. In general, it is not recommended to use another antithyroid medication after a severe allergic reaction to the initial agent, as there is a chance of cross-reactivity. Thyroidectomy and radioiodine ablation were deemed risky due to severe thyrotoxicosis and the possibility of precipitating thyroid storm. For this reason, she was challenged with gradually increasing doses of methimazole under close monitoring. She tolerated 1 mg and 5 mg of methimazole while in hospital, and was eventually up-titrated to a total daily dose of 20 mg. There was a resultant reduction of free T4 to 29.9 pmol/L and free T3 to 7.83 pmol/L. Radioiodine ablation was arranged with discontinuation of methimazole one week prior. Thyroid uptake and scan showed 24hr uptake of 87.6% (normal 15-35%) and a diffusely enlarged thyroid gland. She was prescribed 370 megabecquerels of I-131, and was counselled to delay pregnancy for a minimum of six months after therapy and until normalization of TSH. Conclusion: This is the first reported case of anaphylaxis secondary to PTU and subsequent tolerance of methimazole. It highlights challenges that can occur in the management of patients with severe thyrotoxicosis, and the importance of multidisciplinary care in this situation. References: (1) Shtessel M, Toh J, Gavrilova T. Anaphylaxis as a delayed reaction of methimazole therapy. Ann Allergy Asthma Immunol. 2015;115:245-246.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».