Case of acute mixed liver injury due to hypothyroidism

Duong, Nikki; Lee, Alice; Lewis, James H.

doi:10.1136/bcr-2017-222373

Cited by 9 publications

(11 citation statements)

References 16 publications

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“…However, liver dysfunction also occurred in those with normal thyroid function as shown in the present patient and in the previous literature [4,26]. Duong et al reported a case of acute mixed liver injury due to hypothyroidism [27]. These cases remind us that the safe dose range of thyroid hormone is narrow, and that a stable and normal state of thyroid function is critical for human health.…”

Section: Discussionsupporting

confidence: 82%

Liver dysfunction induced by Levothyroxine Sodium Tablets (Euthyrox®) in a hypothyroid patient with Hashimoto’s thyroiditis: case report and literature review

Zhang

Shen

et al. 2019

Endocr J

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A 49-year-old woman with hypothyroidism developed liver dysfunction after increasing dose of levothyroxine (L-T4) (Euthyrox ®) from 25 μg to 50 μg. Viral hepatitis, autoimmune hepatitis and non-alcoholic steatohepatitis (NASH) were ruled out with examinations. She had no concurrent medication and had no history of infectious, chronic or any other autoimmune diseases. After cessation of Levothyroxine Sodium Tablets (Euthyrox ®), liver enzymes gradually returned to normal. She was diagnosed levothyroxine-induced liver injury, based on criteria proposed in "Diagnosis and treatment guideline on drug-induced liver injury" issued by the Chinese Medical Association (2015). As an alternative 25 μg qod of Levothyroxine Sodium Tablets (Letrox ®) was tried and increased gradually up to 75 μg daily. Since then liver enzymes have remained within normal range. The main difference of additive for both tablets is whether it contains lactose or not: Euthyrox ® contains lactose which caused no liver injury, thus excluding the possibility that an additive of Euthyrox ® contributed to liver injury. The relatively quicker and larger replacement with synthetic T4 for hypothyroidism inducing transient thyrotoxicosis was suspected, although thyroid function was normal. Immune-mediated drug-induced liver injury (DILI) was also not excluded. This is a rare case of drug-induced liver injury due to levothyroxine tablets. It reminded us that when replacement with synthetic T4 for hypothyroidism is done, smaller-dose initiation and slower-speed increase may be useful for treatment of cases similar to genetically susceptible individuals.

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Section: Discussionsupporting

confidence: 82%

Liver dysfunction induced by Levothyroxine Sodium Tablets (Euthyrox®) in a hypothyroid patient with Hashimoto’s thyroiditis: case report and literature review

Zhang

Shen

et al. 2019

Endocr J

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“…Aside from occasionally mildly elevated liver enzymes (ALP, ALT), a specific association between hypothyroidism and clinically apparent hepatopathy has not been extensively described in the veterinary literature; however, an association between hypothyroidism and gallbladder mucoceles is well described in dogs [16,17]. Several case reports in human medicine highlight an association between hypothyroidism, hepatic disease, and hyperammonemic coma, with at least one report of acute hypothyroid-induced mixed hepatopathy [18][19][20]. Cage-side measurement of ammonia is less commonly performed in veterinary medicine, and thus, the ammonia status of the presented case is unknown.…”

Section: Discussionmentioning

confidence: 99%

Myxedema Coma and Acute Hepatopathy in a Dog with Severe Atherosclerosis

Giralico

Makii

Pray

et al. 2021

Case Reports in Veterinary Medicine

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A 9-year-old male intact mixed-breed dog was presented to The Ohio State University Veterinary Medical Center for evaluation of two days’ duration of weakness, lethargy, inappetence, and one episode of vomiting the day of presentation. On presentation, the dog was depressed and tetraparetic. He was noted to be icteric and dehydrated. Obesity and truncal alopecia with a “rat tail” appearance were observed. Diagnostic testing revealed evidence of an acute hepatopathy and peritonitis. Given the dog’s neurologic status, physical examination abnormalities, including a “tragic facial expression”, and hyperlipidemia, there was concern for possible myxedema coma. A thyroid panel was consistent with hypothyroidism. The dog experienced respiratory arrest prior to initiation of therapy, and an autopsy confirmed the presence of subacute necrotizing cholangiohepatitis, marked atherosclerosis, and severe thyroid atrophy. These clinical and pathologic changes were supportive of myxedema coma.

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“…Despite the good knowledge of the effect of thyroid hormones on the entire human metabolism, the effects of hypothyroidism on the liver are not always well understood [13]. However, minim liver injuries and/or minim to moderate abnormalities of hepatic enzymes are often frequently associated to thyroid diseases [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, most cases of hypertransaminasemia caused by hypothyroidism are reported as sporadic observations [9,11,12,19,20]. These hypertransaminasemias may be isolated or may be associated with cholestasis defining mixed hepatic injury [13] or more rarely integrate into the setting of more severe clinical presentation with hyperammonemia [21] or severe hepatic insufficiency with hepatic encephalopathy [22].…”

Section: Discussionmentioning

confidence: 99%