# A client taking methimazole reports anorexia, pruritus, and right-upper-quadrant pain. ALT and AST are more than 3 times the upper limit of normal. Which action is the priority?

> source: MyMerci (mymerci.kr)  
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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client taking methimazole reports anorexia, pruritus, and right-upper-quadrant pain. ALT and AST are more than 3 times the upper limit of normal. Which action is the priority?

## Option

1. Give the next dose with food and repeat laboratory tests in 6 months.
2. Double the dose because hyperthyroidism can affect liver tests.
3. Hold methimazole and notify the prescriber promptly for evaluation of clinically significant liver injury. **✔ Correct answer**
4. Reassure the client that pruritus proves the drug is effective.

**Correct answer: 3**

## Explanation

Compatible symptoms and transaminases above 3 times the upper limit require prompt discontinuation and evaluation under the methimazole label.

## In-depth explanation

Quick answer
Hold methimazole and escalate possible clinically significant hepatotoxicity.

Why this is correct
The label directs liver-function evaluation for anorexia, pruritus, or right-upper-quadrant pain and prompt discontinuation when clinically significant liver abnormality includes transaminases above 3 times normal.

Easy analogy or mental picture
When the organ-processing plant sounds an alarm, do not send another load through it.

Memory hook
Methimazole plus RUQ symptoms and marked enzymes: hold and evaluate.

NCLEX decision rule
Use symptom and laboratory thresholds together; do not normalize a trend that meets a labeled stop criterion.

Why the other choices are wrong
Food, dose escalation, and delayed review do not address the injury mechanism.References
1DailyMed: MethimazoleAgranulocytosis warning and prompt discontinuation for clinically significant liver abnormality

## Clinical scenario

Hepatic adverse-effect review
Assess symptoms, bilirubin, alkaline phosphatase, ALT, AST, current dose, and alternative causes before authorized rechallenge.

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