{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:00:45Z","timestamp":1785297645718,"version":"3.55.0"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Clinically significant liver enzyme elevation is a recognized adverse effect of antithyroid drugs (ATDs) and often necessitates treatment discontinuation and switching to an alternative agent. Using TriNetX, we conducted a retrospective cohort study of patients with hyperthyroidism who initiated methimazole\/carbimazole (MMI) or propylthiouracil (PTU), developed significant liver enzyme elevation within 4 months, and switched to the alternate ATD within 12 months. Baseline characteristics were indexed to the initial prescription, and outcomes were assessed for 120 days following the second prescription. The cohort included 276 patients who switched from MMI to PTU and 82 patients who switched from PTU to MMI. Significant liver enzyme elevation occurred in 111\/276 (40%) and 25\/82 (30%) of patients, respectively. Hepatocellular-pattern elevation occurred in 48\/276 (17%) and 13\/82 (16%), while cholestatic-pattern elevation occurred in 91\/276 (33%) and 15\/82 (18%). These findings demonstrate that significant liver injury after ATD switching is frequent but not inevitable and occurs at comparable rates across switch groups, underscoring the need for close biochemical monitoring and individualized treatment decisions.<\/jats:p>","DOI":"10.1093\/ejendo\/lvag123","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:24:39Z","timestamp":1784546679000},"page":"K1-K4","source":"Crossref","is-referenced-by-count":0,"title":["Risk of significant liver enzyme elevation after switching antithyroid drugs"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6771-337X","authenticated-orcid":false,"given":"Rena","family":"Pollack","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Hadassah Medical Center , Jerusalem ,","place":["Israel"]},{"name":"Faculty of Medicine, Hebrew University of Jerusalem , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4939-5800","authenticated-orcid":false,"given":"Joshua","family":"Stokar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Hadassah Medical Center , Jerusalem ,","place":["Israel"]},{"name":"Faculty of Medicine, Hebrew University of Jerusalem , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"issue":"10","key":"2026072823111767600_lvag123-B1","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1089\/thy.2016.0229","article-title":"2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis","volume":"26","author":"Ross","year":"2016","journal-title":"Thyroid"},{"issue":"4","key":"2026072823111767600_lvag123-B2","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1159\/000490384","article-title":"2018 European Thyroid Association guideline for the management of Graves\u2019 hyperthyroidism","volume":"7","author":"Kahaly","year":"2018","journal-title":"Eur Thyroid J"},{"key":"2026072823111767600_lvag123-B3","author":"National Institute of Diabetes and Digestive and Kidney Diseases"},{"key":"2026072823111767600_lvag123-B4","volume-title":"Drug Safety Communication: New Boxed Warning on Severe Liver Injury with Propylthiouracil","author":"U.S. Food and Drug Administration","year":"2010"},{"issue":"9","key":"2026072823111767600_lvag123-B5","doi-asserted-by":"publisher","first-page":"3671","DOI":"10.1210\/jc.2013-1954","article-title":"Comparative effectiveness of therapies for Graves\u2019 hyperthyroidism: a systematic review and network meta-analysis","volume":"98","author":"Sundaresh","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2026072823111767600_lvag123-B6","doi-asserted-by":"publisher","first-page":"207","DOI":"10.4158\/EP-2019-0221","article-title":"Side effects of PTU and MMI in the treatment of hyperthyroidism: a systematic review and meta-analysis","volume":"26","author":"Yu","year":"2020","journal-title":"Endocr Pract"},{"issue":"2","key":"2026072823111767600_lvag123-B7","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1111\/j.1365-2265.2012.04365.x","article-title":"Hepatotoxicity and cutaneous reactions after antithyroid drug administration","volume":"77","author":"Otsuka","year":"2012","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"1","key":"2026072823111767600_lvag123-B8","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvad133","article-title":"Clinical characteristics and outcomes of patients with antithyroid drug-related liver injury","volume":"8","author":"Khan","year":"2023","journal-title":"J Endocr Soc"},{"key":"2026072823111767600_lvag123-B9","unstructured":"National Cancer Institute, U.S. Department of Health and Human Services\n          . Common Terminology Criteria for Adverse Events (CTCAE). Version 6.0. 2025."},{"key":"2026072823111767600_lvag123-B10","volume-title":"Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012"}],"container-title":["European Journal of Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejendo\/advance-article-pdf\/doi\/10.1093\/ejendo\/lvag123\/69687872\/lvag123.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejendo\/article-pdf\/195\/1\/K1\/69687872\/lvag123.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejendo\/article-pdf\/195\/1\/K1\/69687872\/lvag123.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T03:11:26Z","timestamp":1785294686000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/195\/1\/K1\/8739141"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejendo\/lvag123","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7,1]]}}}