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But, it has been founded that myeloperoxidase (MPO)-mediated metabolism of PTU led to a reactive metabolite formation which covalently bounded to leukocytes proteins.44 This reactions might be responsible for agranulocytosis as a deleterious adverse effect of PTU.44,45 Many variations in drug metabolizing enzymes in humans has been identified.46 As methimazole is suspected to metabolized to reactive intermediate(s) which might involve in the hepatic injury induced by this drug,36,41 polymorphism in drug metabolizing enzymes might has a role in the idiosyncratic nature of the hepatic injury induced by this antithyroid medication

Figure 1 3 Influencing factors of Hcy level 3.1 Genetic factors Genetic errors or deficiencies in key enzymes of Hcy metabolism can lead to HHcy