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Propylthiouracil/thiamazole Muscular disorders: case report A 28-year-old woman developed muscular disorders initially during treatment with propylthiouracil and later during treatment with thiamazole [methimazole] for Grave’s hyperthyroidism. The woman started receiving thiamazole 10mg for two weeks [frequency not stated], which was replaced by propylthiouracil 50mg twice daily after she tried to become pregnant. Six weeks after propylthiouracil initiation, she reported severe leg cramps. Laboratory investigations showed the following levels: creatine kinase 926 U/L, thyroid stimulating hormone (TSH) 0.005 mcIU/mL, alkaline phosphatase (ALP) 137 U/L, ALT 64 U/L and AST 53 U/L; before thiamazole initiation, her TSH, ALP, ALT and AST levels were 0.011 mcIU/mL, 135 U/L, 34 U/L, and 22 U/L, respectively. Propylthiouracil was discontinued and, 1 week later, the woman’s muscle pain had decreased and she had a creatine kinase level of 188 U/L, an ALP level of 137 U/L, an ALT level of 38 U/L and an AST level of 25 U/L. She tested positive for pregnancy and started receiving thiamazole 5 mg/day. Two weeks later, she experienced mild muscle pain after resuming exercise. At this time, she had the following levels: creatine kinase 314 U/L, TSH 0.012 mcIU/mL, ALP 126 U/L, ALT 27 U/L and AST 31 U/L. Despite continued exercise her muscle pain disappeared and, after 3 weeks, her creatine kinase level was 53 U/L and her ALP, ALT and AST levels had normalised [patient treatment not clearly stated]. Two months later, thiamazole was discontinued after her free thyroxine level had normalised; her TSH level was 0.019 mcIU/mL. She remained asymptomatic and, at 42 weeks’ gestation, she gave birth to a normal euthyroid girl. Fein HG. Myopathy associated with multiple thionamides during therapy of Graves hyperthyroidism. 89th Annual Meeting of the Endocrine Society : abstr. P4-366, 2 801081088 Jun 2007 [abstract] - USA

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Reactions 7 Jul 2007 No. 1159