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      Carbimazole induced rhabdomyolysis


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          Carbimazole is a commonly used antithyroid drug (ATD), which is associated with several well-established side effects. However, Carbimazole-induced rhabdomyolysis is rarely reported in the literature. We report a 27-year-old male who presented with upper limb myalgia and significantly raised creatine kinase elevation, 1-month post commencement of Carbimazole for Graves’ disease. Carbimazole was ceased with subsequent clinical and biochemical improvement. Though the pathophysiology remains unclear, we hope to raise awareness regarding this rare adverse effect with a view to promote early recognition and prompt discontinuation of the offending medication caused by a commonly used medication in endocrinology.

          Learning points
          • Musculoskeletal complaints can relate to unidentified and untreated hyperthyroidism. However one must be mindful that the treatment for these disorders can too induce myopathies.

          • ATD-induced myopathy should be considered when there is a temporal relationship between introduction of ATDs and the onset of symptoms.

          • If ATD-induced myopathy is being considered, other causes of myopathy should still be outruled.

          • Prompt discontinuation of potentially offending medications may provide resolution of symptoms and avoid significant consequences.

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          Most cited references8

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          Musculoskeletal manifestations of thyroid disease.

          The relationship between thyroid disorders and rheumatic diseases is significant.Thyroid diseases not only emulate rheumatic disease with findings such as myopathy or arthropathy but also frequently manifest with primary rheumatologic complaints that the practitioner should be wary of, such as calcium pyrophosphate deposition disease. There is increasing recognition of the prevalence of autoimmune thyroid diseases in patients with connective tissue disorder, highlighting a common mechanism for the disease pathogenesis, which requires further inquiry. Copyright © 2010. Published by Elsevier Inc.
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            Stepwise Approach to Myopathy in Systemic Disease

            Muscle diseases can constitute a large variety of both acquired and hereditary disorders. Myopathies in systemic disease results from several different disease processes including endocrine, inflammatory, paraneoplastic, infectious, drug- and toxin-induced, critical illness myopathy, metabolic, and myopathies with other systemic disorders. Patients with systemic myopathies often present acutely or sub acutely. On the other hand, familial myopathies or dystrophies generally present in a chronic fashion with exceptions of metabolic myopathies where symptoms on occasion can be precipitated acutely. Most of the inflammatory myopathies can have a chance association with malignant lesions; the incidence appears to be specifically increased only in patients with dermatomyositis. In dealing with myopathies associated with systemic illnesses, the focus will be on the acquired causes. Management is beyond the scope of this chapter. Prognosis is based upon the underlying cause and, most of the time, carries a good prognosis. In order to approach a patient with suspected myopathy from systemic disease, a stepwise approach is utilized.
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              Carbimazole-induced myositis in the treatment of Graves' disease: a complication in genetically susceptible individuals?

              A 24-year-old Chinese woman with Graves' disease presented with myositis two months after treatment with carbimazole. The patient's myositis resolved with hydration and cessation of carbimazole. No other causes of myositis were found, and a change in the medication to propylthiouracil was uneventful. Review of the literature suggests a possible genetic susceptibility, as the majority of reported cases are Asian in origin, similar to patients who present with thyroid periodic paralysis. Changing the antithyroid drugs (ATDs) administered, decreasing the dose of pre-existing ATDs in the treatment regimen or addition of levothyroxine has been shown to result in clinical improvement of this complication. These observations suggest various mechanisms of carbimazole-induced myositis in the treatment of Graves' disease, including the direct effect of ATDs on myocytes, immune-related responses secondary to ATDs and rapid decrements in thyroid hormone with ensuing myositis.

                Author and article information

                Endocrinol Diabetes Metab Case Rep
                Endocrinol Diabetes Metab Case Rep
                Endocrinology, Diabetes & Metabolism Case Reports
                Bioscientifica Ltd (Bristol )
                07 June 2021
                : 2021
                : 21-0006
                [1 ]Department of Medicine , St Vincent’s University Hospital, Dublin, Ireland
                [2 ]Department of Endocrinology , University of Western Australia, Perth, Western Australia, Australia
                Author notes
                Correspondence should be addressed to N O’Donnell; Email: niavodonnell@ 123456gmail.com
                © The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                : 28 April 2021
                : 07 June 2021
                Unusual Effects of Medical Treatment
                Unusual Effects of Medical Treatment

                adult,male,white,australia,thyroid,unusual effects of medical treatment,july,2021


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