Prescription
Name
Course
Institution
Date
Description: Mrs. Jennifer Jackson is a 47-year-old female who has just been diagnosed with Graves’ disease. She is otherwise healthy. After further discussion, she is not interested in radioactive therapy or surgery.
Prescription
Jason Smith, M.D
123 Main Street
Tel: 123 456 789
Mail: smithjason123@
Patient Name: Jennifer Jackson
Age: 47; D.O.B. 02/03/1977
Address: 234 Main Street
Date: 05/22/2024
Rx: Methimazole
Sig: 10 mg
Form: Tablet
Disp: Take 10 mg orally three times daily
Quantity: 90 tablets
Refills: 0 (Initial treatment; follow-up required)
Prescriber Signature: ________________________
Key Concerns and Management
- Agranulocytosis
Methimazole has agranulocytosis (granulocyte count <500/µL) as one of its side effects (DynaMed, n.d.). According to Fredette et al. (2024), agranulocytosis is rare but is a significant side effect of methimazole among patients with Graves’ disease (GD). Agranulocytosis causes white blood cell count to drop to levels that may be considered dangerous. In addition, patients with agranulocytosis may experience adverse symptoms, including vomiting, rhinorrhea, generalized myalgias, and sore throat (Fredette et al., 2024). The drop in white blood count levels is also likely to expose Mrs. Jackson to infections. At her age, managing the condition is necessary and must be urgent.
Management and Education
While agranulocytosis is rare, if it manifests, it is severe and poses significant health risks. Therefore, Mrs. Jackson needs regular monitoring, including a complete blood count (CBC). CBC tests will monitor her white blood cell levels, especially in the first three months after treatment. Secondly, Mrs. Jackson must be educated about the signs she should watch out for. The signs that she may manifest include fever, sore throat, and mouth ulcers. She should seek immediate medical attention if any of these signs manifest. In addition, she should immediately stop the medication and contact a clinic or go to an emergency room no later than two days (UpToDate, 2024). Furthermore, to manage hyperthyroidism and control thyrotoxicosis symptoms that may manifest during agranulocytosis, the healthcare team should consider β-Blockade to help manage the symptoms, prolonged use of the saturated solution of potassium iodide (SSKI) or cholestyramine, steroids, lithium, and plasmapheresis (Fredette et al., 2024).
- Hepatotoxicity
Methimazole can cause liver toxicity, leading to hepatitis or liver failure (DynaMed, n.d.). According to a 2020 report by the National Library of Medicine on the relationship between methimazole and liver toxicity, the researchers found that the medication can cause idiosyncratic liver injury and hepatotoxicity within 2 to 12 weeks of usage. They also found that the patterns of enzyme elevation were mixed, alongside evidence of hepatocellular patterns (National Institute of Diabetes and Digestive and Kidney Diseases, 2020).
Management and Education
Methimazole-induced hepatotoxicity is also rare, but its possibility cannot be annulled. If it manifests, Mrs. Jackson will likely suffer symptoms such as upper stomach pain, nausea, sick, queasy, unusual tiredness, dark-colored urine, and pale or light-colored stool (National Institute of Diabetes and Digestive and Kidney Diseases, 2020). Liver function tests (LFT) should be performed before starting medication and routinely after starting the medication. Mrs. Jackson must also be educated about the symptoms to look out for, including yellow skin or eyes (jaundice), dark urine, severe fatigue, and pain or tenderness in the upper abdomen. If she notices these symptoms, she should stop the medication and seek immediate medical evaluation (UpToDate, 2024). Although it is not indicated if Mrs. Jackson is a drug or alcohol user, it is also important that she is cautioned to avoid alcohol and medications such as acetaminophen because they can stress the liver and worsen her situation.
References
DynaMed (n.d.) Methimazole. https://www.dynamed.com/drug-monograph/methimazole
Fredette, M. E., Pillai, S. S., Ibrahim, O., Kochhar, M., Cotton, T. M., Rogo, T. O., Scheffler, M. D., & Bauer, A. J. (2024). The Evaluation and Management of Methimazole-Induced Agranulocytosis in the Pediatric Patient: A case report and review of the literature. Hormone Research in Paediatrics, 1–8. https://doi.org/10.1159/000536508
National Institute of Diabetes and Digestive and Kidney Diseases. (2020, January 22). Methimazole. LiverTox – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK548406/
UpToDate (2024, June 10). Thionamides in the treatment of Graves’ disease – UpToDate. https://www.uptodate.com/contents/thionamides-in-the-treatment-of-graves-disease