21 October 2025
: Case report 
Methimazole-Induced Antithyroid Arthritis Syndrome in Graves' Disease Management: A Case Report
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease, Adverse events of drug therapy
Kin-Weng Sun
E 1,2, Aixin Wu ABDF 1*
DOI: 10.12659/AJCR.949509
Am J Case Rep 2025; 26:e949509
Table 3 Reported male patients with antithyroid arthritis syndrome.
| Reference/Published years | Age | Drug | Other drugs | Duration of treatment initiation | Dosage (mg/d) | Symptoms | Laboratory test | Treatment |
|---|---|---|---|---|---|---|---|---|
| []/195423 | 50 | MMI | None specified | 5.5 weeks | 60 | Rash, fever, arthralgia | ESR↑, Agranulocytosis | Drug withdrawal |
| []/195423 | 55 | MMI | Digitalis, ephedrine | 4 weeks | 60 | Pain, swelling, anorexia, nausea, vomiting and polyarthritis | Albuminuria, hemoglobin↑ | 3 weeks of corticosteroid therapy, ending in sudden death |
| []/199924 | 50 | CBZ | Cetirizine, ranitidine, coproxamol, fluoxetine | 5 days | 60 | Fever, pain, swelling, migratory polyarthritis | CRP↑, ESR↑ | Drug withdrawal + PTU 600 mg/d +Atenolol 100 mg/d + morphine + corticosteroid for 2 weeks |
| []/201225 | 64 | CBZ | Propranolol 30–60 mg/d | 5 weeks | 20→30 | Fever, rash, intermittent and migratory arthralgia | ALT↑, AST↑, CRP↑, ESR↑, ANCA (−), C4(−), IgE 664 U/ml | Drug withdrawal + NSAIDs + antihistamines for 13 days |
| []/202026 | 30 | MMI | Propranolol 30 mg/d | 4 weeks | 20 | Pain, swelling, tachycardia, polyarthritis | ANA (+), ANCA (−) | Drug withdrawal + PTU 100 mg/d + corticosteriod for 4 weeks → dose tapered & stopped |
| []/20216 | 42 | MMI | Metoprolol 100 mg/d → Propranolol 30 mg/d | 5 weeks | 20→40 | Asymmetric polyarthritis, fever | CRP↑, ANCA (−) | PTU + corticosteriod resolved in 2 weeks |
| []/202127 | 50 | CBZ | None specified | 2 weeks | 30 | Fever, tachycardia, asymmetric polyarthritis | Total leukocyte count↑, CRP↑, ESR↑ | Drug withdrawal, levothyroxine 37.5 mcg/day for 6 weeks → dose tapered & stopped |
| ALT – alanine aminotransferase; ANA – antinuclear antibody; ANCA – anti-neutrophil cytoplasmic antibody; AST – aspartate aminotransferase; CBZ – carbimazole; CRP – C-reactive protein; ESR – erythrocyte sedimentation rate; IgE – immunoglobulin E; MMI – methimazole; NSAIDs – non-steroidal anti-inflammatory drugs; PTU – propylthiouracil. | ||||||||