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.
How do you manage a patient who has developed adverse effects of ATD?
Minor cutaneous reactions may be managed with concurrent antihistamine therapy without stopping the antithyroid drug (ATD). Any patient who develops agranulocytosis or other serious side effects while taking either MMI or PTU, use of the other medication is generally contraindicated owing to risk of cross- reactivity between the two medications.
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