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Graves' disease — UKMLA MCQ

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HardEndocrinologyGraves' diseaseUKMLAMRCP Part 1

A patient develops biochemically confirmed acute pancreatitis 3 weeks after starting carbimazole. Gallstones, alcohol, triglycerides and other medicines are excluded. Thyrotoxicosis still requires treatment. What is the key medicine-safety action?

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Correct answer: E — Stop carbimazole permanently and avoid subsequent re-exposure

The best answer is “Stop carbimazole permanently and avoid subsequent re-exposure”. MHRA advises immediate discontinuation of carbimazole when acute pancreatitis occurs and avoidance of re-exposure because recurrence can be rapid and life-threatening. Dose reduction, enzyme replacement or cholecystectomy does not remove an idiosyncratic drug reaction. Ongoing thyroid treatment requires specialist selection of a genuinely alternative strategy rather than a carbimazole rechallenge.

Reference: MHRA Drug Safety Update, carbimazole and acute pancreatitis: https://www.gov.uk/drug-safety-update/carbimazole-risk-of-acute-pancreatitis