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A 20-year-old female presented with complaints of thyroid swelling and showed signs and symptoms of thyrotoxicosis and fine-needle aspiration cytology (FNAC) was requested by the surgeon. On examination of FNAC smear, it showed thyroid follicular cells with atypical features like bizarre giant cells, pseudo nuclear inclusions, and mitotic figure. Correlation between clinical history and cytomorphologic features was done and it was reported as atypical changes in thyroid probably due to carbimazole-induced changes. It helped the patient, as radical surgery and its untoward complications were avoided.
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ABSTRACT We describe a case of a patient with Graves' disease who failed to respond to carbimazole. Our patient remained thyrotoxic despite maximal carbimazole dosage. Our patient was switched to propylthiouracil which subsequently made the patient euthyroid. The patient was then definitively treated with radioiodine treatment. This case highlights the need to increase awareness of carbimazole resistance to prevent patients from being given escalating doses of carbimazole which increases the probability of adverse effects and extend their time in the hyperthyroid state.
ABSTRACT
Abstract Iraqi propolis (PR) have powerful antioxidants, free radical scavenger and anti-inflammatory constituents makes it to have a protective effect on renal function. The aim of this study is to evaluate the possible protective effect of Iraqi propolis (PR) on renal toxicity induced by Carbimazole (CB) and levothyroxine (TR) in rats. Forty-two adult female albino rats randomized into six groups: control, PR, CB, TR, PR + CB and PR +TR. Rats orally treated by gavage for six weeks. Haematological and histopathological analyses performed. A significant increase in hemoglobin percentage, RBC count and Haematocrit percentage after exposure to PR + CB and PR + TR combinations compared to control. CB dose of 0.01mg /g for six weeks causes renal damage in female rats and TR dose of 0.1µg/g for six weeks causes renal degenerative effects. Rats treated with PR+TR show normal appearance in kidney tissue, glomeruli and renal tubules compared to thyroxin group alone. In addition, PR+ CB treatment show more improvement in renal tissue, normal glomeruli and renal tubules compared to CB alone. It is concluded that PR combination with CB or TR might have an effect on the blood, further studies needed to confirm this effect on human to be used for anemia accompanied thyroid disruptions. In addition, further studies needed to confirm renal protective effect on human to be used for this effect.
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Introduction: Pancytopenia, potentially a life threateningcondition is a rare manifestation of Graves’ disease and canoccur due to many causes. Antithyroid drug therapy beingone of the important cause, is associated with serious adverseeffects like agranulocytosis and aplastic anemia. Earlyrecognition and management of this serious complication isimportant.Case Report: We report a case of Graves’ disease in an adultmale on carbimazole, who developed pancytopenia, twoyears after restarting the therapy after an initial treatment offour years. He recovered completely after withdrawing theoffending agent, along with blood transfusion and haematinicstreatment. Subsequently he underwent radioactive iodineablation as a definitive treatment for Graves’ disease.Conclusion: Early recognition of pancytopenia in a patientof Graves’ disease on antithyroid medication is important toprevent complications. Radioactive iodine ablation therapyor thyroid surgery are preferred in them, as other antithyroidmedications are contraindicated.
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This study investigated the effect of ethanol extract of Cyperus rotundus rhizome on hyperlipidemia induced with carbimazole and cholesterol in male wister rats. Acute toxicity analysis with the Cyperus rotundus rhizome extract produced no letality even at higher doses. Hyperlipidemia was induced using 400 mg/kg cholesterol and 2 mg/kg carbimazole. The lipemic control group was administered cholesterol and carbimazole but not the normal control group. Cholesterol and carbimazole administration caused a significant (p = 0.05) increase in the Total Cholesterol, Triglyceride (TG), Low Density Lipoprotein (LDL), non-High Density Lipoprotein (non-HDL) Cholesterol and LDL/HDL ratio and a significant (p = .05) decrease in the levels of HDL cholesterol in the lipemic control when compared to the normal control. Treatment with ethanol extract of Cyperus rotundus at 250 mg/kg, 500 mg/kg and the standard hypolipidemic drug (simvastatin) at 5mg/kg significantly (p = 0.05) reduced total cholesterol, TG, LDL, LDL/HDL ratio, total non-HDL Cholesterol and also significantly (p=.05) increased the level of HDL cholesterol when compared to the non-treatment group (the lipemic control group). Results of the present study indicate that Cyperus rotundus rhizome contains principles that have hypolipidemic potentials and which compare effectively with standard clinically used therapeutic Hypolipidemic agent, simvastatin.
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Aims: The role of thyroid hormones as important mediator of glucose metabolism and body weight dynamics had long been established. This study was therefore designed to evaluate the effect of standard thyro-active drugs in comparison to crude nutritional extracts, on blood glucose level and body weight changes. Methodology: Albino wistar rats weighing between 100 - 150g were randomly assigned to seven groups of seven rats each. Group 1 served as control, while groups 2-7 were orally administered Fresh orange juice(FOJ) (1500mg/kg), Fresh soybean(FSB) (0.01mg/kg), levothyroxine (LVT) (0.01mg/kg), carbimazole (Carb) (0.01mg/kg), FSB+LVT and FOJ+Carb respectively once daily for twenty eight days. Weekly weight records were taken and the difference calculated as weight changes. The animals were sacrificed and blood samples collected by cardiac puncture. Serum was obtained by standard procedure and used for blood glucose estimation. Results: Separate treatment with both FOJ and FSB significantly (P<0.05) increased the blood glucose levels and body weight compared to control. Levothyroxine significantly (P<0.05) increased the blood glucose levels but significantly (P<0.05) decreased the body weight compared to the FOJ treated group. Carbimazole significantly (P<0.05) decreased the blood glucose levels compared to the control, FOJ and FSB treated groups. FSB+LVT treatment significantly (P<0.05) decreased the blood glucose levels compared to the LVT group and also significantly (P<0.05) decreased the body weight compared to the control, FOJ and FSB groups. FOJ+Carbimazole combination treatment significantly (P<0.05) decreased the blood glucose levels compared to LVT treatment and also significantly (P<0.05) decreased the body weight compared to the FOJ and FSB groups. FOJ significantly reduced T4 and T3 levels compared to control. FOJ, Carb and FOJ+Carb significantly (p<0.05) reduced T4 level compared to control. Conclusion: The acclaimed antithyroid activity of FOJ and FSB did not appear to directly correlate with that of carbimazole, a standard antithyroid drug, considering their effect on blood glucose level and body weight changes. However their combination treatment with Carb and LVT respectively, showed similar pattern with carbimazole.
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Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well, but some may develop rare life threatening side effects such as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole. This resolved after substitution with propylthiouracil. The clinical course was complicated by neutropaenic septicaemia and atrial fibrillation.
Subject(s)
ThyrotoxicosisABSTRACT
Aplasia cutis congenita (ACC) is a rare anomaly presenting with absence of skin. It was first reported by Cordon in 1767. About 70% of cases manifests as a solitary defect on the scalp, but sometimes it may occur as multiple lesions. The lesions are typically well demarcated, non-inflamed, and they range in size from 0.5cm to 10cm. ACC may be circular, oval, linear, or stellate in configuration. At birth, lesions may appear as scars or ulcers1. They may appear as parchment-like scars with alopecia. Most lesions occur on the scalp vertex just lateral to the midline, but defects may also occur on the face, the trunk, or the limbs, sometimes symmetrically. The depth may involve only the epidermis and the upper dermis, resulting in minimal alopecic scarring, or the defect may extend to the deep dermis, the subcutaneous tissue, or rarely the periosteum, the skull, and the dura. ACC is most often a benign isolated defect, but it can be associated with other physical anomalies or malformation syndromes. Frieden classified them into 9 groups based on the number and presence or absence of other anomalies1. Nearly 86 percent belong to the first group with a solitary lesion. We report a case of Aplasia Cutis Congenita secondary to maternal exposure to carbimazole during pregnancy.
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We report a 33-year-old Malay lady who presented with fever, tonsillitis and pharyngitis a month after initiation of antithyroid therapy (carbimazole 15 mg tds) for thyrotoxicosis by her general practitioner. She was still clinically and biochemically thyrotoxic but not in thyroid storm. At that time, she was also confirmed to be four weeks pregnant. Her full blood count revealed neutropaenia with an absolute neutrophil count of 0.036 × 109/L. Bone marrow aspirate and trephine were compatible with carbimazole-related agranulocytosis. Carbimazole was discontinued and she was given broad spectrum antibiotics and Granulocyte Colony Stimulating Factor (GCSF), to which she responded. Verapamil was used for symptomatic heart rate control instead of beta-blockers as she had a history of bronchial asthma. The patient subsequently opted for termination of pregnancy after which she was given radioactive iodine I131 (10 mCi) for definitive therapy of her thyrotoxicosis. In conclusion, carbimazole-related agranulocytosis is an important entity to recognise and treat early to prevent morbidity and mortality. Termination of pregnancy was carried out as the treatment given during the episode of agranulocytosis may have negative effects on foetal viability and growth.