Amiodarone-induced liver injury with bright liver sign: A case report

Figure 1 Changes in liver and thyroid function before and after amiodarone administration. A: Amiodarone dosing timeline; B: Dynamic changes in liver function tests during amiodarone therapy. The line graph illustrates serial trends in serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels throughout the clinical course. Liver enzyme levels increased substantially during prolonged amiodarone therapy and gradually declined following amiodarone discontinuation and initiation of hepatoprotective treatment; C: Dynamic changes in thyroid function tests during amiodarone therapy. The line graph illustrates serial trends in serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels during amiodarone treatment. During therapy, FT4 levels progressively increased, whereas FT3 levels decreased. TSH was not appropriately suppressed despite elevated FT4 levels. These thyroid function abnormalities persisted after discontinuation of amiodarone. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; FT3: Free triiodothyronine; FT4: Free thyroxine; TSH: Thyroid stimulating hormone; QD: Daily.

Figure 2 Serial liver imaging before and after amiodarone therapy. A and B: Chest computed tomography (CT) performed before initiation of amiodarone therapy (January 16, 2025) demonstrates homogeneous hepatic attenuation [approximately 52 Hounsfield units (HU)], comparable to that of the spleen; C and D: Chest CT obtained after amiodarone therapy (June 3, 2025) reveals a marked increase in hepatic attenuation (approximately 120 HU), substantially exceeding splenic attenuation. The liver is normal in size and contour, with smooth margins and no focal lesions; E-I: Abdominal magnetic resonance imaging performed after amiodarone therapy (June 5, 2025) demonstrates isointense hepatic parenchymal signal on T1-weighted imaging and mildly hypointense signal on T2-weighted imaging. No appreciable signal loss is observed on in-phase or out-of-phase sequences.