J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 6, Number 1, January 2015, pages 30-32

Hepatotoxicity and Anti-Nuclear Antibody Positivity During Methimazole Therapy for Thyrotoxicosis: A Case Report

Tables

**Table 1.** The Laboratory Values Before, During and After the Methimazole Treatment
	Methimazole pre-treatment	During methimazole treatment	Methimazole post-treatment
AST (N: 0 - 34 U/L)	16	201	29
ALT (N: 0 - 49 U/L)	15	417	35
ALP (N: 39 - 155 U/L)		326	150
GGT (N: 0 - 73 U/L)	19	1,385	1,088
Total biluribin (N: 0.3 - 1.2 mg/dL)		3.1	1.07
Direct biluribin (N: 0 - 0.2 mg/dL)		2.43	0.5
Amylase (N: 30 - 130 U/L)		42	40
WBC (N: 4.6 - 10.2 × 10³/μL)	8.26	6.4	10.5
FT3 (N: 2.3 - 4.2 pg/mL)	5.24	2.37	2.33
FT4 (N: 0.7 - 1.48 ng/dL)		0.8	0.9
TSH (N: 0.27 - 4.2 mU/L)	0.005	2.1	1.78
Anti-TPO (N: 0 - 34 IU/mL)	293.6
Anti-Tg (N: 0 - 115 IU/mL)	15.1

**Table 2.** CIOMS/RUCAM Scale
Type of liver injury	Hepatocellular	Cholestatic/mixed	Points
Score analysis: 0 or lower: relationship with the drug excluded; 1 - 2: unlikely; 3 - 5: possible; 6 - 8: probable; > 8: highly probable.
Time of onset of the event	First exposure	Second exposure	First exposure
Time from drug intake until reaction onset	5 - 90 days	1 - 15 days	5 - 90 days
Time from drug intake until reaction onset	< 5 or > 90 days	> 15 days	< 5 or > 90 days
Time from drug withdrawal until reaction onset	≤ 15 days	≤ 15 days	≤ 30 days
Risk factors	Alcohol	Alcohol or pregnancy	+1
Risk factors	Age ≥ 55 years	Age ≥ 55 years	+1
Course of the reaction	> 50% improvement 8 days	-	+3
	> 50% improvement 30 days	> 50% improvement 180 days	+2
	-	< 50% improvement 180 days	+1
	Lack of information or no improvement	Lack of information or no improvement	+0
	Worsening or < 50% improvement 30 days	-	-1