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Khongsaengbhak T, Atthakitmongkol T, Tanwandee T. Liver Dysfunction in Hyperthyroidism. Hepat Med 2024; 16:81-89. [PMID: 39534784 PMCID: PMC11556236 DOI: 10.2147/hmer.s487794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 11/05/2024] [Indexed: 11/16/2024] Open
Abstract
Background Thyrotoxicosis is often associated with abnormal liver tests. This study aimed to characterize the clinical features and laboratory findings in thyrotoxic patients with liver abnormalities and to identify predictive factors for differentiating thyroid storm within this population. Methods This is a retrospective review of thyrotoxic patients with hepatic dysfunction between January 2015, and January 2021, at Siriraj Hospital, Thailand. Univariate and multivariate analyses were performed to identify the factors associated with thyroid storm. Results Among 771 thyrotoxic patients, 43 revealed abnormal liver tests within six months of diagnosis (5.58%). The mean age was 53.16 ± 15.10 years, with a female predominance (60.5%), and the majority (97.7%) were diagnosed with Graves' disease. The most common comorbidities were atrial fibrillation, heart failure, and dyslipidemia. Hepatic dysfunction presented as non-specific, with 46.5% showing a cholestatic pattern, 30.2% a mixed pattern, and 20.9% a hepatocellular pattern. The most possible etiologies of hepatic dysfunction were hyperthyroidism-related hepatitis (41.9%) with atrial fibrillation with congestive hepatopathy (38.9%), concomitant with chronic hepatitis C infection (14.0%), and methimazole-induced hepatic dysfunction (9.3%). The younger age, congestive heart failure, and total bilirubin levels ≥ 3.0 mg/dL were independent factors in distinguishing clinical thyroid storm among thyrotoxic patients without thyroid storm. Conclusion Liver abnormalities can be observed in patients with thyrotoxicosis. The possible causes are multifactorial, including hyperthyroidism-related hepatitis, atrial fibrillation with congestive hepatopathy, and chronic hepatitis C infection. Younger age, congestive heart failure, and total bilirubin ≥ 3.0 mg/dL were predictive factors for thyroid storm diagnosis among thyrotoxic patients.
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Affiliation(s)
| | - Thanapat Atthakitmongkol
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tawesak Tanwandee
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Fang D, Li S, Zhou C, Wang Y, Yuan G, Zhang H, Rao M. Comparing the prognostic impact of 131I and/or artificial liver support system on liver function failure combined with hyperthyroidism. Endocr Connect 2024; 13:e240330. [PMID: 39240241 PMCID: PMC11466263 DOI: 10.1530/ec-24-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 09/06/2024] [Indexed: 09/07/2024]
Abstract
Objective Hyperthyroidism, a prevalent endocrine disorder, can lead to complications such as liver failure due to the liver's essential role in thyroid hormone metabolism. The study aimed to elucidate the respective contributions of 131I and/or ALSS in managing hyperthyroidism alongside liver failure. Methods A retrospective analysis was carried out on 74 patients diagnosed with severe liver failure in the context of Graves' disease. Patients were categorized into three groups: group A (n = 34) received 131I treatment, group B (n = 17) underwent 131I and ALSS treatment, and group C (n = 24) received artificial liver support system (ALSS) treatment alone. Results Throughout the treatment period, the liver function indexes in all groups exhibited a declining trend. The thyroid function of group A and group B treated with 131I was significantly improved compared to that before treatment. There was no significant change in thyroid function in group C. After the correction of hyperthyroidism, significant improvements were observed in the liver function of individuals in groups A and B, particularly with more noticeable amelioration compared to group C. After two months of treatment, the efficacy rates for the three groups were 79.41%, 82.35%, and 60.87% respectively. Mortality rates of the three groups were 5.88%, 17.65%, and 36% (P < 0.01). Group B, receiving both 131I and ALSS treatments, exhibited a lower mortality rate than group C. Conclusion In cases of severe liver failure accompanied by hyperthyroidism, prompt administration of 131I is recommended to alleviate the adverse effects of hyperthyroidism on liver function and facilitate a conducive environment for the recovery of liver functionality.
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Affiliation(s)
- Danzhou Fang
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shiying Li
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changgu Zhou
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yirui Wang
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gengbiao Yuan
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - HuiHui Zhang
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Maohua Rao
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Li C, Wang KL, Hu JH, Su HB. Clinical manifestations and early effectiveness of methimazole in patients with graves' hyperthyroidism-related severe hepatic dysfunction. Scand J Gastroenterol 2023; 58:1514-1522. [PMID: 37545358 DOI: 10.1080/00365521.2023.2244107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/29/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Graves' hyperthyroidism (GH) is often accompanied by mild to moderate liver injury, but severe hepatic dysfunction (SHD) is relatively rare. Whether patients with GH-related SHD can be treated with methimazole (MMI) remains controversial. This study aimed to determine the clinical characteristics and to evaluate the role of low-dose MMI for such patients. METHODS 33 patients with GH-related SHD were selected for this retrospective study in the Fifth Medical Center of Chinese PLA General Hospital from January 2017 to July 2022. The clinical manifestations, therapeutic responses, and effectiveness of MMI were evaluated. RESULTS Systemic jaundice (100.0%), yellow urine (100.0%), fatigue (87.9%), and goiter (66.7%) were the main symptoms. Total bilirubin (TBIL) had no linear correlation with free triiodothyronine (FT3) (r = -0.023, p = .899), free thyroxine (FT4) (r = 0.111, p = .540), T3 (r = -0.144, p = .425), and T4 (r = 0.037, p = .837). On the 14th day after admission, FT3, FT4, T3, T4, TBIL, direct bilirubin (DBIL), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), and international normalized ratio (INR) decreased compared with the baseline (p < .05). The decrease rates of FT3, FT4, T3, T4, TBIL, and DBIL in the MMI group were higher than those in the non-MMI group (p < .05). The improvement rate of the MMI group (77.8%) was higher than that of the non-MMI group (9.5%, p = .001). MMI treatment is an independent predictor affecting the early improvement of patients (OR = 0.022, p = .010). CONCLUSIONS The main clinical manifestations of patients with GH-related SHD were symptoms related to liver disease. Low-dose MMI was safe and effective for them.
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Affiliation(s)
- Chen Li
- Department of Hepatology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Clinical Medical School, Peking University, Beijing, China
| | - Kai-Li Wang
- Department of Hepatology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Clinical Medical School, Peking University, Beijing, China
| | - Jin-Hua Hu
- Department of Hepatology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Clinical Medical School, Peking University, Beijing, China
| | - Hai-Bin Su
- Department of Hepatology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Clinical Medical School, Peking University, Beijing, China
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Xie H, Chen D, Zhang J, Yang R, Gu W, Wang X. Characteristics of Graves' disease in children and adolescents in Nanjing: A retrospective investigation study. Front Public Health 2022; 10:993733. [PMID: 36304250 PMCID: PMC9592843 DOI: 10.3389/fpubh.2022.993733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/20/2022] [Indexed: 01/26/2023] Open
Abstract
Objective This cross-sectional study analyzed the clinical characteristics of newly diagnosed Graves' disease (GD) in children and adolescents to provide clinical evidence for the early diagnosis of GD. Method From 2013 to 2019, information on children and adolescents with newly diagnosed GD admitted to the Department of Endocrinology, Children's Hospital of Nanjing Medical University, was collected, including clinical features and laboratory tests. The data were summarized and statistically analyzed. Result This study included 204 cases of newly diagnosed GD, with 158 females and 46 males. The average age at initial diagnosis was 8.9 ± 2.9 years. A total of 132 cases (64.7%) had symptoms before puberty, and 72 cases (35.3%) had symptoms during puberty. Goiter was detected in 193 cases (94.6%). There were 140 cases (68.6%) of exophthalmos, and 21.4% (30/140) were infiltrative. At initial diagnosis, 10 cases (4.9%) reported leukopenia, 18 cases (8.8%) reported neutropenia, and 15 cases (7.4%) reported mild anemia. There was 1 (0.5%) case of thrombocytopenia and 1 (0.5%) case of agranulocytosis. Fifty-four cases (26.5%) had impaired liver function. Conclusion GD is more common in female children and adolescents. Parents may ignore their children's hypermetabolic symptoms in the early stages of GD. Routine blood and liver function tests are recommended at initial diagnosis to exclude abnormal hemogram and liver function.
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Affiliation(s)
- Hang Xie
- Office of Clinical Research, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Dandan Chen
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ju Zhang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ruize Yang
- Department of Public Health, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Gu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Wei Gu
| | - Xu Wang
- Office of Clinical Research, Children's Hospital of Nanjing Medical University, Nanjing, China,Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China,Xu Wang
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Yorke E. Hyperthyroidism and Liver Dysfunction: A Review of a Common Comorbidity. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221074672. [PMID: 35153522 PMCID: PMC8829710 DOI: 10.1177/11795514221074672] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022] Open
Abstract
Deranged liver enzymes due to hyperthyroidism rather than intrinsic liver pathology are not uncommon. The reported prevalence of liver biochemical abnormalities in patients with untreated thyrotoxicosis varies widely ranging from 15% to 76%. The suggested causes of liver dysfunction include direct hepatocyte injury, co-morbid heart failure, associated autoimmune conditions (especially in the setting of Graves' Disease), preexisting liver disease and drugs including antithyroid medications. Although, some patients may have a pattern of mild liver injury, about 1% to 2% can have fulminant hepatitis. Liver enzymes can return to normalcy in as many as 77% to 83% of patients once the initiations of thionamides are started in a timely fashion, which can help forestall complications and prevent or minimize multi-organ dysfunction. Clinicians should maintain a high index of suspicion for underlying hyperthyroidism in patients presenting with unexplained liver dysfunction or unexplained jaundice.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
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Rao M, Wang Y, Ren J, Chen Y, Zheng C, Xiong Y, Yan Q, Li S, Yuan G. Effect of 131I with and without artificial liver support system in patients with Graves' disease and severe liver dysfunction: A retrospective study. Front Endocrinol (Lausanne) 2022; 13:1034374. [PMID: 36329888 PMCID: PMC9622763 DOI: 10.3389/fendo.2022.1034374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Treatment decision-making in Graves' disease (GD) with severe liver dysfunction (LD) is a clinical challenge. This research was carried out to evaluate the effect of radioiodine (131I) with or without an artificial liver support system (ALSS) in GD patients with severe LD. METHODS In total, 45 patients diagnosed with GD and severe LD were enrolled and allocated to two groups: patients treated with 131I alone (n=30) (Group A)and patients by a combination of 131I and ALSS (n=15)(Group B). Liver function, thyroid hormone concentrations, therapeutic efficacy, and the cost of treatment were compared between the two groups. RESULTS Thyroid hormone concentrations were lower 2 weeks after 131I treatment, but no deterioration in liver function was identified. There was no statistically significant difference in the treatment efficacy between the two groups. The hospital stay, total cost, and daily cost were lower in patients treated with 131I alone than in those treated with 131I and an ALSS (p<0.05). CONCLUSION The key point of treating GD patients with severe LD is to control the GD.131I is recommended as an effective and safe and should be applied as soon as possible once the diagnosis is clarified; however, when used in combination with an ALSS, there was no substantial improvement in therapeutic efficacy.
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Affiliation(s)
- Maohua Rao
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yirui Wang
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianli Ren
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Chen
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Chenxi Zheng
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yalan Xiong
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingbo Yan
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shiying Li
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
- *Correspondence: Shiying Li, ; Gengbiao Yuan,
| | - Gengbiao Yuan
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Shiying Li, ; Gengbiao Yuan,
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Lavruk KZ, Dudiy PF, Skrypnyk NV, Mishchuk VH, Vytvytskiy ZY. Clinical-laboratory and ultrasound parallels of changes in the liver and thyroid gland in diffuse toxic goiter. J Med Life 2022; 15:78-88. [PMID: 35186140 PMCID: PMC8852630 DOI: 10.25122/jml-2021-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022] Open
Abstract
Detection of liver dysfunction in patients with diffuse toxic goiter (DTG) at an early stage allows for correcting it in time with appropriate therapy; therefore, diagnosing hepatobiliary system lesions in these patients is an important medical issue. We examined 62 patients, divided into two groups depending on the duration of the disease. The first group included patients with a disease duration of up to two years, the second group - patients with a disease duration of more than two years. The study and comparison of laboratory and multiparametric ultrasound criteria of liver and thyroid dysfunction were performed. Analysis of ultrasound signs of hepatobiliary system lesions in patients in the two groups showed that they were more common in the second group. There is a correlation between the stiffness of the parenchyma of the thyroid gland and liver and the duration of the disease, the level of free thyroxine (T4f), and antibodies to thyroid-stimulating hormone receptors (ArTTG). Increased liver stiffness was more common in patients with ArTTG levels above 20 IU/ml, and the degree of F1 fibrosis was higher at T4f greater than 50 pmol/l. To assess the condition of a patient with DTG and the need to correct treatment tactics, it is advisable to use the criteria of multiparametric ultrasound examination of the hepatobiliary system and thyroid gland.
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Affiliation(s)
- Khrystyna Zynoviivna Lavruk
- Department of Radiology and Radiation Medicine, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine,Corresponding Author: Khrystyna Zynoviivna Lavruk, Department of Radiology and Radiation Medicine of Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine. E-mail:
| | - Petro Fedorovych Dudiy
- Department of Radiology and Radiation Medicine, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | | | - Vasyl Hryhorovych Mishchuk
- Department of General Practice (Family Medicine), Physical Rehabilitation and Sports Medicine, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
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Opoku‐Akyeampong NAAS, Agyei‐Nkansah A, Yorke E. Liver dysfunction associated with hyperthyroidism: Lessons from 2 Case reports. Clin Case Rep 2021; 9:e04067. [PMID: 34136225 PMCID: PMC8190517 DOI: 10.1002/ccr3.4067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
Hyperthyroidism may impact liver biochemistry negatively. Clinicians need a high index of suspicion in patients presenting with unexplained deranged liver enzymes or jaundice. Timely initiation of thionamides portends good prognosis.
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Affiliation(s)
| | - Adwoa Agyei‐Nkansah
- Department of Medicine & TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
| | - Ernest Yorke
- Department of Medicine & TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
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Yeliosof O, Marshall I. Severe hyperthyroidism without symptoms due to nonthyroidal illness in a child with acute hepatitis: case report and literature review. Ann N Y Acad Sci 2020; 1487:5-11. [PMID: 32965700 DOI: 10.1111/nyas.14493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/10/2020] [Accepted: 08/22/2020] [Indexed: 12/28/2022]
Abstract
While liver enzyme changes are frequently reported in hyperthyroidism, liver dysfunction itself can lead to alterations in thyroid hormone metabolism. However, the exact relationship between hyperthyroidism and liver dysfunction is unclear. We report an 11-year-old boy presenting with acute hepatitis of unknown etiology, who was incidentally found to have asymptomatic biochemical hyperthyroidism. Despite significant total and free T4 elevation, clinical evidence of thyrotoxicosis was absent. Thyroid I-123 uptake was also reduced. Additional testing revealed slight T3 elevation and significant rT3 elevation. Graves' and Hashimoto's thyroiditis testing was negative. We hypothesize that the biochemical hyperthyroidism was due to transient thyroiditis. Although an etiology for the boy's hepatitis was never determined, and an undiagnosed infectious etiology causing subacute thyroiditis was considered, subsequent testing showing positive thyroid peroxidase antibodies, suggesting autoimmune Hashimoto's thyroiditis as the likely cause of the hyperthyroidism. We believe, furthermore, that the absence of symptoms was the result of concurrent nonthyroidal illness resulting in the biochemical findings of slight T3 elevation and significant rT3 increase despite significant T4 elevation.
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Affiliation(s)
- Olga Yeliosof
- Division of Pediatric Endocrinology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ian Marshall
- Division of Pediatric Endocrinology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Tan YW, Sun L, Zhang K, Zhu L. Therapeutic plasma exchange and a double plasma molecular absorption system in the treatment of thyroid storm with severe liver injury: A case report. World J Clin Cases 2019; 7:1184-1190. [PMID: 31183351 PMCID: PMC6547323 DOI: 10.12998/wjcc.v7.i10.1184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/29/2019] [Accepted: 03/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Thyroid storm is resistant to conventional treatments including antithyroid drugs and 131I therapeutic means. Plasma exchange (PE) and double plasma molecular absorption system (DPMAS) can be used as an effective treatment for thyroid storm with severe liver injury.
CASE SUMMARY A 52-year-old woman presented with a 10-day history of nausea and vomiting accompanied by yellowing of the skin and mucosa. Further, her free T3 (FT3) and FT4 levels were significantly elevated, whereas her thyrotropin level was reduced. After admission, her condition continued to deteriorate, and she presented with continued high fever, vomiting, palpitation, and shortness of breath. After being diagnosed with thyroid storm, the patient was immediately treated with PE combined with DPMAS. Her symptoms improved immediately. After three PE + DPMAS treatments, and she was discharged from the hospital. She was treated with methylprednisolone and methylthimidazole. After six months, the patient spontaneously discontinued methylthimidazole treatment. Her previous clinical manifestations and liver dysfunction reoccurred. The patient was treated with PE + DPMAS two times, and her condition rapidly improved. Liver histopathology indicated immunological liver injury.
CONCLUSION Our experience suggests that PE combined with DPMAS can effectively relieve the development of thyroid storm.
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Affiliation(s)
- You-Wen Tan
- Department of Hepatology, the Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
| | - Li Sun
- Department of Hepatology, the Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
| | - Kai Zhang
- Department of Hepatology, the Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
| | - Li Zhu
- Department of Hepatology, the Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
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Wang R, Tan J, Zhang G, Zheng W, Li C. Risk factors of hepatic dysfunction in patients with Graves' hyperthyroidism and the efficacy of 131iodine treatment. Medicine (Baltimore) 2017; 96:e6035. [PMID: 28151911 PMCID: PMC5293474 DOI: 10.1097/md.0000000000006035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hepatic dysfunction is often observed in patients with Graves' hyperthyroidism. The aims of this study were to investigate the risk factors for hepatic dysfunction and to analyze the efficacy of I (radioactive iodine-131) treatment. In total, 2385 patients with Graves' hyperthyroidism (478 males, 1907 females; age 42.8 ± 13.5 years) were involved in our study. Of these, 1552 cases with hepatic dysfunction received I treatment. All clinical data were retrospectively reviewed to explore the risk factors associated with hepatic dysfunction using logistic regression analysis. Furthermore, we observed thyroid and liver function indices for the 1552 subjects at 3, 6 and 12 months after I treatment, in order to evaluate efficacy. Overall, 65% patients were affected by hepatic dysfunction. The most common abnormality was elevated alkaline phosphatase (ALP), of which the prevalence was 52.3%. The percentages of hepatocellular injury type, bile stasis, and mixed type were 45.8%, 32.4%, and 21.8%, respectively. Both univariate and multivariate analyses demonstrated that age, duration of Graves hyperthyroidism, free triiodothyronine (FT3)level, and thyrotrophin receptor antibody (TRAb) concentration were the most significant risk factors predicting hepatic dysfunction. Additionally, the patients with mild hepatic dysfunction, or hepatocellular injury type were more likely to attain normal liver function after I treatment. Furthermore, after I treatment, liver function was more likely to return to normal in the cured group of patients compared with the uncured group. Older patients and cases with a longer history of Graves' hyperthyroidism, higher FT3 or TRAb concentration were more likely to be associated with hepatic dysfunction, and the prognosis of hepatic dysfunction was closely associated with the outcomes of Graves' hyperthyroidism after I treatment.
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12
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Zhang Q, Guan Y, Xiang T, Liu S, Chen Q, Zhang Q. COMBINATION OF MOLECULAR ADSORBENT RECIRCULATING SYSTEM AND RADIOIODINE FOR THE TREATMENT OF CONCURRENT HYPERTHYROIDISM AND SEVERE LIVER DYSFUNCTION: A RETROSPECTIVE COHORT STUDY. Endocr Pract 2016; 23:141-148. [PMID: 27819764 DOI: 10.4158/ep161417.or] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The treatment of hyperthyroidism associated with severe liver dysfunction (LD) is a clinical challenge, and there has been no unified examination of this problem. The objective of this study was to assess the efficacy and safety of radioiodine (131I) in combination with a molecular adsorbent recirculating system (MARS) for the treatment of hyperthyroidism complicated by severe liver LD. METHODS A total of 116 hyperthyroidism patients with concomitant LD who received MARS treatment were studied retrospectively. The patients were grouped according to whether or not they also received 131I treatment: Group 1 (59 patients) received 131I following MARS treatment, while Group 2 (57 cases) received only MARS. Clinical outcomes, including thyroid hormone levels, liver function parameters, and therapeutic efficacy were calculated. RESULTS The overall response rate was significantly greater in Group 1 than in Group 2 (P<.01). The clinical indicators improved significantly in both groups 3 months after treatment compared with before treatment (P<.05), but Group 1 showed a greater improvement. Compared with Group 1, patients in Group 2 had a longer stay in hospital (P<.05), and received more frequent MARS treatments (P<.05). CONCLUSION The combination of MARS and 131I for the treatment of hyperthyroidism complicated by severe LD was effective and safe. The use of this system could rapidly improve liver function and metabolism, allowing 131I therapy to be applied as early as possible with a shortened recovery time of liver function. ABBREVIATIONS ALSS = artificial liver support system ALT = alanine transaminase AST = aspartate transaminase ATD = antithyroid drugs DBil = direct bilirubin FT3 = free tri-iodothyronine FT4 = free thyroxine 131I = radioiodine INR = international normalized ratio LD = liver dysfunction MARS = molecular adsorbent recirculating system MELD = model for end-stage liver disease PT = prothrombin time TBil = total bilirubin TSH = thyroid-stimulating hormone.
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