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Thyrotoxicosis is a common disorder especially in women. Most of the patientstolerate antithyroid medications very well with very few developing life threatening side effects. A 64 years old gentleman was diagnosed with hyperthyroidismsecondary to Grave's disease (autoimmune). He was treated withCarbimazole 20 mg daily. With in a month, he presented with acute cholestatichepatitis. The patient's symptoms and laboratory abnormalities resolved afterwithdrawing the offending drug and controlling his thyroid status first withbeta blocker and subsequently with propylethioracil. Since the mechanism of liver damage is different, antithyroid medications can be interchanged withoutincreasing the risk of further liver damage.
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