Carbimazole-associated Pancreatitis: Report From Western India

Abstract

Pancreatitis is a very rare complication of methimazole and carbimazole therapy. We describe a case of possible carbimazole-associated pancreatitis. A 41-year-old Asian man (with no comorbidities) reported to the hospital with atrial fibrillation and a fast ventricular rate. He was diagnosed with hyperthyroidism due to Graves disease. His rhythm was reverted with amiodarone, and carbimazole was initiated at 15 mg daily for the medical management of Graves disease. Fifteen days later, he presented with acute severe abdominal pain and vomiting with elevated serum amylase 387 U/L (reference range, 28-100 U/L) and lipase levels 206 U/L (reference range, 13-60 U/L). Magnetic resonance imaging showed a bulky pancreas with extensive extrapancreatic fat stranding suggestive of acute pancreatitis. Considering the possibility of carbimazole-related pancreatitis, the drug was withheld. He was managed conservatively, and his pancreatic enzymes normalized within 1 week. The observation suggests that the pancreatitis was a consequence of the therapy with carbimazole. Although it is a rare occurrence, patients taking carbimazole who report abdominal discomfort and vomiting should be evaluated for pancreatitis.

Keywords: Graves disease; carbimazole; pancreatitis.

Figure 1.

^99mTc scan showing diffuse uptake in the entire thyroid gland—overall uptake 3.4%, right lobe uptake 1.5%, and left lobe 2% (normal uptake is 0.4%-1.7%).

Figure 2.

Magnetic resonance cholangiopancreatography images showing bulky pancreas with peripancreatic fat stranding—A, head of pancreas and B, body and tail arrows indicate areas of fat stranding.