Side effects of propylthiouracil
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Side Effects of Propylthiouracil (PTU)
Common Side Effects: Agranulocytosis and Hepatotoxicity
Propylthiouracil (PTU) is a medication commonly used to treat hyperthyroidism, particularly in conditions like Graves' disease. However, its use is associated with several significant side effects. Agranulocytosis, a severe reduction in the number of white blood cells, is one of the most critical adverse reactions. This condition can lead to increased susceptibility to infections and requires immediate medical attention 57. Hepatotoxicity, or liver damage, is another serious side effect of PTU. This can manifest as acute hepatitis and is thought to be immune-mediated, although the exact risk factors remain unclear 19.
Immune-Mediated Reactions: Hypersensitivity and Vasculitis
PTU can also cause immune-mediated hypersensitivity reactions, which may involve multiple organs. These reactions can include symptoms such as high fever, migratory polyarthritis, and even reversible sensorineural deafness . Hypersensitivity vasculitis, characterized by inflammation of the blood vessels, is another well-documented side effect. This condition often improves with the discontinuation of PTU and the administration of glucocorticoids 12.
Pulmonary Complications: Asthma and Interstitial Pneumonia
Pulmonary complications are less common but noteworthy. PTU has been reported to induce asthma in some patients, likely due to its accumulation in neutrophils and subsequent immune reactions . Additionally, PTU-induced nonspecific interstitial pneumonia (NSIP) has been documented, presenting with symptoms like dyspnea, cough, and mild fever. This condition typically improves after the withdrawal of the drug .
Lupus-Like Syndrome and Nephrotoxicity
PTU can occasionally induce a lupus-like syndrome, characterized by symptoms such as rash, serositis, myocarditis, and acute renal insufficiency. This condition is associated with serological markers for lupus and can lead to severe complications like diffuse proliferative lupus nephritis . Early recognition and discontinuation of PTU are crucial for managing these symptoms effectively.
Eosinophilic Pleuritis
Eosinophilic pleuritis, an inflammation of the pleura with a high eosinophil count, is another rare but documented side effect of PTU. This condition is part of the broader spectrum of immunologic side effects associated with thionamides .
Conclusion
While PTU is an effective treatment for hyperthyroidism, it is associated with a range of serious side effects, including agranulocytosis, hepatotoxicity, immune-mediated hypersensitivity reactions, pulmonary complications, lupus-like syndrome, and eosinophilic pleuritis. Early detection and prompt discontinuation of the drug, along with appropriate medical intervention, are essential for managing these adverse reactions effectively. Clinicians should be vigilant in monitoring patients on PTU to ensure safe and effective treatment outcomes.
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