Methimazole-induced acute pancreatitis: a case report

  • Itsuka Kikuchi
  • Nobuyuki Miyata
  • Yukihiro Yoshimura
  • Kazunori Miyamoto
  • Natsuo Tachikawa
Case Report


A 76-year-old Japanese woman was diagnosed with Graves’ disease and was administered methimazole (MMI) 10 mg and potassium iodide 50 mg. After 19 days of the drug regime, she developed high-grade fever and nausea and was admitted to our hospital. Blood test results showed elevated pancreatic enzymes and C-reactive protein levels. Abdominal computed tomography showed swollen pancreas, and she was diagnosed with acute pancreatitis. These abnormalities improved after discontinuation of MMI. Five similar cases have been reported, but this is the first case report without abdominal pain. When acute pancreatitis is observed after the initiation of MMI, drug-induced pancreatitis should be considered as the possible etiology.


Methimazole Drug-induced pancreatitis Acute pancreatitis 


Compliance with ethical standards

Conflict of interest

Itsuka Kikuchi, Nobuyuki Miyata, Yukihiro Yoshimura, Kazunori Miyamoto and Natuo Tachikawa declare that they have no conflict of interest.

Research involving human and/or animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.


  1. 1.
    Yokoe M, Takada T, Mayumi T, et al. Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2015. J Hepatobiliary Pancreat Sci. 2015;22:405–32.CrossRefGoogle Scholar
  2. 2.
    Vinklerová I, Procházka M, Procházka V, et al. Incidence, severity, and etiology of drug induced acute pancreatitis. Dig Dis Sci. 2010;55:2977–81.CrossRefGoogle Scholar
  3. 3.
    Manabu Taguchi M, Yokota H, Koyano, et al. Acute pancreatitis and parotitis induced by methimazole in a patient with Graves’ disease. Clin Endocrinol. 1999;51:667–70.CrossRefGoogle Scholar
  4. 4.
    Mei Yang H, Qu H-C, Deng, et al. Acute pancreatitis induced by methimazole in a patient with Graves’ disease. Thyroid. 2012;22:94–6.CrossRefGoogle Scholar
  5. 5.
    Albin Abraham P, Raghavan R, Patel, et al. Acute pancreatitis induced by methimazole therapy. Case Rep Gastroenterol. 2012;6:223–31.CrossRefGoogle Scholar
  6. 6.
    Jung JH, Hahm JR, Jung J, et al. Acute pancreatitis by methimazole treatment in a 51-year-old Korean man: a case report. J Korean Med Sci. 2014;29:1170–3.CrossRefGoogle Scholar
  7. 7.
    Agito K, Manni A. Acute pancreatitis induced by methimazole in a patient with subclinical hyperthyroidism. J Investig Med High Impact Case Rep. 2015. Scholar
  8. 8.
    Takeda K. Pancreatitis: advances in diagnosis and treatment. Nippon Naika Gakkai Zasshi. 2010;99:16 (In Japanese).Google Scholar
  9. 9.
    Durr GHK. Acute pancreatitis. In: Howat HT, Scarles H, editors. The exocrine pancreas. London: WB Saunders; 1972. pp. 352–401.Google Scholar
  10. 10.
    Tetuo Takayama Y, Soga T, Yokota, et al. A study on acute painless pancreatitis. J Gifu Med Assoc. 1990;3:325–30 (In Japanese).Google Scholar
  11. 11.
    Fitzgerald O. Painless pancreatitis and other painless pancreatic disorders. Clin gastroenterol. 1972;1:195–218.Google Scholar
  12. 12.
    Ootsuki M, Kihara Y, Kikuchi K, et al. Acute pancreatitis epidemiological survey. Grant-in-aid for scientific research. Overcoming research project on intractable diseases. Research on intractable pancreatic disease. Summary of Heisei 14–16. Sharing research report. 2005;35–37.Google Scholar
  13. 13.
    Lai S-W, Lin C-L, Liao K-F, et al. Use of methimazole and risk of acute pancreatitis: a case-control study in Taiwan. Indian J Pharmacol. 2016;48:192–5.CrossRefGoogle Scholar
  14. 14.
    Marino M, Vitti P, Chiovato L, et al. Graves’ disease. Jameson JL, de Groot LJ, editors. Endocrinology: adult and pediatric, 7th ed. Philadelphia: Saunders and Elsevier, 2016; pp. 1437–64.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of GastroenterologyJikei University HospitalTokyoJapan
  2. 2.Department of Infectious DiseaseYokohama Municipal Citizen’s HospitalYokohamaJapan
  3. 3.Department of Endocrine DiseaseYokohama Municipal Citizen’s HospitalYokohamaJapan

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