41 year old lady with a recent diagnosis hyperthyroidism presents with fever (39 C), pharyngitis, maculopapular rash on her trunk. She discontinued methimazole 3 weeks ago. Her CT abdomen is negative for obstruction of the common bile duct or evidence of cholecystitis. What is the best management of this patient?
Labs
WBC 0.8 K/microL
Total Bilirubin 13.3 mg/dL
Direct Bilirubin 9.5 mg/dL
ALT 187 Units/L
AST 83 Units/L
Alk Phos 407 Units/L
TSH < 0.02
Free T4 3.7
Hep A IgM negative / Hep B sAg negative / Hep B cAb IgM negative / Hep C Ab negative
Liver failure due to methimazole use. Woeber KA. Methimazole-induced hepatotoxicity. Endocr Pract 2002;8:222-4. PMID: 12467281