Thyrotoxic hepatitis
https://doi.org/10.14341/probl201763146-50
Abstract
In most cases, liver pathology in hyperthyroidism is confined to asymptomatic changes in laboratory indices, while clinical signs are much rarer. Three clinical variants of liver pathology in patients with hyperthyroidism can be differentiated: drug-induced hepatitis that develop in response to administration of thyrostatic agents (mainly propylthiouracil); concomitant autoimmune liver diseases (autoimmune hepatitis, primary biliary cirrhosis), and hepatopathies as a direct manifestation of thyrotoxicosis (thyrotoxic hepatitis). Thyrotoxic hepatitis is a rare condition difficult to diagnose. The variety of etiological factor of liver pathology in hyperthyroidism, universal clinical symptoms, and the lack of specific histological markers make it difficult to make a correct diagnosis.
A clinical case of Graves’ disease complicated with severe thyrotoxic hepatitis, the edema-ascites syndrome and hyperbilirubinemia is reported. The patient was diagnosed with thyrotoxic hepatitis after all other reasons for liver pathology have been ruled out. The concomitant thyrogenic myocardiodystrophy, cardiomegaly and atrial fibrillation required ruling out the diagnosis of cardiogenic liver injury and made diagnosing more difficult. Normalization of the thyroid status in patients receiving mercazolyl therapy was accompanied by alleviation of clinical symptoms of hepatitis and the positive dynamics of the indices of liver function tests.
A brief review of the data on clinical variants and mechanisms of liver injury in patients with thyrotoxicosis is presented.
About the Authors
Dmitrij V. PikulevMunicipal Clinical Hospital no. 30
Russian Federation
MD, PhD, assistant Professor
Competing Interests:
Конфликт интересов не заявляется
Aleksej V. Klemenov
Municipal Clinical Hospital no. 30
Russian Federation
MD, PhD, assistant Professor
Competing Interests:
Конфликт интересов не заявляется
References
1. Kubota S, Amino N, Matsumoto Y, et al. Serial changes in liver function tests in patients with thyrotoxicosis induced by graves’ disease and painless thyroiditis. Thyroid. 2008;18(3):283-287. doi: 10.1089/thy.2007.0189
2. Burra P. Liver abnormalities and endocrine diseases. Best Pract Res Clin Gastroenterol. 2013;27(4):553-563. doi: 10.1016/j.bpg.2013.06.014
3. Breidert M, Offensperger S, Blum HE, Fischer R. Weight loss and severe jaundice in a patient with hyperthyroidism. Z Gastroenterol. 2011;49(9):1267-1269. doi: 10.1055/s-0029-1246059
4. de Campos Mazo DF, de Vasconcelos GB, Pereira MA, et al. Clinical spectrum and therapeutic approach to hepatocellular injury in patients with hyperthyroidism. Clin Exp Gastroenterol. 2013;6:9-17. doi: 10.2147/ceg.S39358
5. Khemichian S, Fong TL. Hepatic dysfunction in hyperthyroidism. Gastroenterol Hepatol (N Y). 2011;7(5):337-339. PMC3127041.
6. Shetty S, Rajasekaran S, Venkatakrishnan L. Grave’s disease and primary biliary cirrhosis-an unusual and challenging association. J Clin Exp Hepatol. 2014;4(1):66-67. doi: 10.1016/j.jceh.2013.08.001
7. Jhummon NP, Tohooloo B, Qu S. Iodine-131 induced hepatotoxicity in previously healthy patients with grave’s disease. Thyroid Res. 2013;6:4. doi: 10.1186/1756-6614-6-4
8. Sarkhy A, Persad R, Tarnopolsky M. Muscle weakness in a girl with autoimmune hepatitis and graves’ disease. Eur J Pediatr. 2009;168(2):241-243. doi: 10.1007/s00431-008-0738-6
9. Barzilay-Yoseph L, Shabun A, Shilo L, et al. Thyrotoxic hepatitis. Isr Med Assoc J. 2011;13(7):448-450.
Supplementary files
|
|
1. Алгоритм ведения пациентов с поражением печени на фоне гипертиреоза [4]. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(107KB)
|
Indexing metadata ▾ | |
Review
For citations:
Pikulev D.V., Klemenov A.V. Thyrotoxic hepatitis. Problems of Endocrinology. 2017;63(1):46-50. https://doi.org/10.14341/probl201763146-50
Views:
23917
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
.jpg){kind=logo}
