P3789 - Antithyroid Drug-Associated Liver Injury: A Systematic Review

Adeel Khan, MD¹, Aamir Shahzad, MD², Fateen Ata, MD¹, Afia Aziz, MD¹, Hana Elamin, MD³, Zohaib Yousaf, MD², Anthony Donato, MD^2
1Hamad Medical Corporation, Doha, Ar Rayyan, Qatar; ²Reading Hospital, Reading, PA; ³National University, Sudan, Doha, Ar Rayyan, Qatar

Introduction: Antithyroid drug (ATD) associated drug-induced liver injury (DILI) has a prevalence of up to 2.5%. We aim to assess the characteristics and overall outcomes of adult patients ( >18 years) with DILI associated with ATD and the differences between ATDs.

Methods: We searched PUBMED, SCOPUS, and EMBASE to identify eligible articles. We defined DILI as bilirubin ≥ 2.5 mg/dL or INR > 1.5 with any rise in ALT, AST, or ALP, or an elevation of ALT or AST >5 times or ALP >2 times the ULN without jaundice/coagulopathy. RUCAM score was used to assess the causality and the R-factor to assess the pattern of DILI. Mean (SD), median (IQR), percentages, t-test, Mann Whitney U, and Chi-square/Fisher's exact test were performed for analysis.

Results: The final review included 100 articles describing 271 patients, of which 148 (70.8%) were female. The mean age was 42.9 ± 17.2 years. Graves' disease was the most common indication for antithyroid drug. Carbimazole or methimazole (CBZ/MMI) was the most common offending agent, causing DILI in 132 (55.7%), while propylthiouracil (PTU) caused in 105 (44.3%). DILI patterns were nearly as often hepatocellular (41.8%) and cholestatic (41.3%) with mixed pattern in 16.9%. Outcomes included death in 11.8% and liver transplantation in 6.4%. Complete resolution was noted in 79.6% of cases, with median time (IQR) to resolution of 45 (20-90) days. Comparing cases of CBZ/MMI to PTU, patients in the PTU group had a higher initial bilirubin, initial AST, initial ALT, peak ALT, peak AST, severe and fatal DILI, liver transplantation, and mortality compared to CBZ/MMI. Rechallenge of antithyroid medication was infrequently reported (n=16) but was successful in 75%.

Discussion: Drug-induced liver injury due to antithyroid drugs can present with both hepatocellular and cholestatic pictures, and should prompt immediate discontinuation of the drug. In the published literature to date, PTI-induced DILI may have worse outcomes compared to CBZ/MMI. Referral to a hepatologist should be considered if severe, as transplantation is required in some cases.



Disclosures:


Adeel Khan, MD¹, Aamir Shahzad, MD², Fateen Ata, MD¹, Afia Aziz, MD¹, Hana Elamin, MD³, Zohaib Yousaf, MD², Anthony Donato, MD². P3789 - Antithyroid Drug-Associated Liver Injury: A Systematic Review, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.