Autoimmune Hepatitis Associated with Graves' Disease

Cui, Binglin; Abe, Masanori; Hidata, Satoshi; Nakanishi, Seiji; Matsuura, Bunzo; Michitaka, Kojiro; Yamamoto, Kazuhisa; Horiike, Norio; Onji, Morikazu

doi:10.2169/internalmedicine.42.331

Cited by 24 publications

(11 citation statements)

References 17 publications

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“…Differentiating between autoimmune hepatitis and PTU-induced autoimmune hepatitis can be challenging and liver biopsy results may provide a clue to diagnosis, with autoimmune hepatits demonstrating more features of chronic inflammation as opposed to PTU-induced autoimmune hepatitis with more acute features [20].…”

Section: Clinical Presentationmentioning

confidence: 99%

Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

Akmal

Kung²

2014

Expert Opinion on Drug Safety

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PTU is known to cause severe hepatic failure, particularly in children. Its use in children should be avoided. In adults, it is beneficial to use in the first trimester of pregnancy and thyroid storm. In the rest of the adult population, it should be used with caution. Carbimazole and MMI are associated with less severe hepatic injury and should be preferred when choosing thionamides as a treatment option.

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Section: Clinical Presentationmentioning

confidence: 99%

Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

Akmal

Kung²

2014

Expert Opinion on Drug Safety

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“…Type 2 is associated with liver kidney microsomal (LKM) antibody and usually presents with similar symptoms in younger children. This type is associated with other immune disorders, in particular, Grave's disease [6]. Type 3 is the least common and is characterized by anti-soluble liver antigen [11].…”

Section: Introductionmentioning

confidence: 99%

Muscle weakness in a girl with autoimmune hepatitis and Graves’ disease

2008

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Autoimmune hepatitis (AIH) is a chronic hepatic autoimmune disease of unknown etiology associated with inflammatory changes and autoantibodies. The combination of AIH, Grave's disease, and myasthenia gravis (MG) is rare, with only one other case reported. We report a pediatric patient with AIH type 2 and Grave's disease who developed MG whilst on a treatment with corticosteroids. A 13-year-old girl, diagnosed with thyrotoxicosis, was identified as having AIH type 2. During the course of her therapy, she developed muscle weakness. Investigations revealed increased anti-acetylcholine receptor (AChR) antibodies and her electromyography (EMG) was characteristic for MG. Her course is described here. This case highlights the importance of investigating muscle weakness in severely ill hospitalized patients.

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“…Whether the presence of ANA in these patients represents the effects of PTU, a nonspecific autoimmune phenotype, or AIH in particular, may represent an intractable dilemma. There are cases of ANA-positive hepatitis developing after more than a year of taking PTU, which were eventually attributed to AIH (11).…”

Section: Discussionmentioning

confidence: 99%

Propylthiouracil‐associated liver failure presenting as probable autoimmune hepatitis in a child with Graves' disease

Sipe¹,

Su²,

Posselt³

et al. 2006

Pediatric Transplantation

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This case describes a young girl with Graves' disease, who presented with fulminant hepatic failure 9 months into propylthiouracil (PTU) therapy. Her clinical presentation was consistent with 'probable autoimmune hepatitis,' as defined by the International Autoimmune Hepatitis Group scoring system. Despite discontinuation of PTU and high-dose steroid therapy, she required liver transplantation. Subsequent pathology could not definitively rule out autoimmune hepatitis. PTU is an important cause of drug-related liver failure in children, and clinicians should be mindful that it is frequently used in patients who already have an underlying risk of autoimmune liver disease.

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Autoimmune Hepatitis Associated with Graves' Disease

Cited by 24 publications

References 17 publications

Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity

Muscle weakness in a girl with autoimmune hepatitis and Graves’ disease

Propylthiouracil‐associated liver failure presenting as probable autoimmune hepatitis in a child with Graves' disease

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