Q:

What are the common side effects of antithyroid drugs?

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A 30-year-old woman presents with complaints of palpitations, tremulousness and weight loss of around 4 kg (despite a good appetite) over the last 2 months. On examination, she is anxious, has a pulse rate of 100/min, warm and moist peripheries, fine tremors of the outstretched hands and a visible goiter. No obvious abnormalities in the eyes. Her last menstrual period was 15 days ago. Her primary care physician orders for laboratory examination which reveals normal hemogram with an erythrocyte sedimentation rate of 25 mm in the first hour. Thyroid stimulating hormone (TSH) <0.001 mIU/L and total T4 28 mg/dL. A diagnosis of thyrotoxicosis is made. She is started on beta-blockers and she is asked to get a technetium uptake scan and review.

What are the common side effects of antithyroid drugs?

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The minor side effects include urticaria, arthralgia, arthritis, fever, transient granulocytopenia, gastrointestinal upset and alterations in taste and smell. The major side effects include agranulocytosis, and very rarely aplastic anemia, thrombocytopenia, toxic hepatitis (PTU), cholestatic hepatitis (MMI), vasculitis, hypoprothrombinemia (PTU), hypoglycemia due to anti-insulin anti-bodies (MMI) and pancreatitis (MMI).

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