Propylthiouracil

Abstract

Diffuse alveolar haemorrhage: case report A 45-year-old woman developed diffuse alveolar haemorrhage during treatment with propylthiouracil for thyroid storm* . The woman presented with palpitations and shortness of breath for 3 days. Her medical history was significant for hyperthyroidism secondary to Grave’s disease. On presentation, she was in moderate respiratory distress and required oxygen support. Her lab tests showed undetectable TSH and Burch-Wartofsky score was 75. Therefore, she was shifted to the ICU for severe acute thyroid storm. Subsequently, her transthoracic echocardiogram showed new onset reduced heart failure with an ejection fraction of 30%, which lead to cardiogenic shock. Then, she developed anuric renal failure need haemodialysis. Thereafter, she started receiving treatment with hydrocortisone along with thiamazole [methimazole] and metoprolol. However, due to insufficient improvement, thiamazole was changed to propylthiouracil [route and dosage not stated]. Then, her renal and cardiac function improved. On day 6 of treatment with propylthiouracil, she developed intermittent haemoptysis, diffuse alveolar infiltrates, decrease in haemoglobin and haematocrit and hypoxaemic respiratory failure. Due to which, she required intubation. It was considered that she developed diffuse alveolar haemorrhage. Therefore, the woman’s treatment with propylthiouracil was discontinued. She then started receiving thiamazole along with methylprednisolone and unspecified empiric antibiotics. Later, her condition improved with ventilator support and bronchoscopy showed stable condition.