ACQUIRED SIDEROBLASTIC ANEMIA AND CHOLEST ASIS IN A HYPERTHYROID PATIENT TREATED WITH METHIMAZOLE AND ATENOLOL

The authors describe a 62 year-old white male who was diagnosed as aut oimmune hyperthyroidism and treated with methimazole and atenolol. Ten days later he showed itching, jaundice and choluria. All drugs were d iscontinued. The patient was given radioactive iodine. Two months late r direct serum bilirubin levels reached 35 mg%. Endoscopic retrograde cholangiogram evidenced normal extrahepatic biliary ducts. The percuta neous liver biopsy showed marked cholestasis specially in the centrolo bular zone with a slight infiltrate of mononuclear cells in the portal areas. Together with the liver disease the patient presented an anemi c syndrome. Bone marrow aspiration showed rich cellularity, Perls stai ning showed 70% sideroblasts, with 10% ringed sideroblasts and increas ed extracorpuscular iron. The patient's evolution was satisfactory. Tw enty months after the beginning of the disease clinical and biochemica l tests were normal. A new bone marrow aspiration rendered normal. Hep atic cholestasis suffered by our patient was probably due to an advers e reaction of methimazole. Physiopathology of reversible sideroblastic anemia is discussed.