Cholestatic Hepatitis in Graves' Disease: A Diagnostic Challenge

Haddaden, Metri; Hanna, Angy; Odish, Fadi; Husami, Samir; Imam, Zaid; Tahhan, Mamon

doi:10.14309/crj.0000000000000526

Cited by 2 publications

(1 citation statement)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, rare but severe hepatotoxicity, such as cholestatic jaundice may occur. [1,2] No known effective medical intervention has been existed. Therapeutic plasma exchange (TPE) is a blood purification method that can immediately remove harmful plasma constituents and has been reported to successfully treat severe cholestatic jaundice induced by MMI.…”

Section: Introductionmentioning

confidence: 99%

An unusual evolution of thyroid function after therapeutic plasma exchange in Graves’ disease with cholestatic jaundice: A case report

Jin,

Feng,

2024

Medicine

View full text Add to dashboard Cite

Rationale: Methimazole (MMI) is the first-line agent in the treatment of hyperthyroidism. However, rare but severe cholestatic jaundice may occur. Therapeutic plasma exchange (TPE) may provide an alternative treatment for such patients and they received thyroidectomy/radioactive iodine ablation or continued oral anti hyperthyroidism medication immediately after TPE session in the reported literatures. The case reported here is, to our knowledge, the first to describe the long interval between anti hyperthyroidism therapy and TPE in such patients. Patient concerns: A 49-year-old Chinese woman had developed worsening jaundice 3 weeks after receiving methimazole (20 mg/day) for the treatment of hyperthyroidism secondary to Graves’ disease (GD). Additionally, she had a 2-year history of type 2 diabetes. Diagnosis: Hyperthyroidism secondary to GD, MMI-induced severe cholestatic jaundice and type 2 diabetes. Interventions: Methimazole was discontinued and the patient received 3 times of TPE, about 3-month glucocorticoid treatment, insulin administration accordingly and other conventional liver-protecting therapy. Outcomes: Her thyroid function was stabilized with small dose of thyroxine substitution and euthyroid status persisted after thyroxine discontinuation until hyperthyroidism recurred 7 months later while her cholestatic jaundice was eventually recovered by about 3-month glucocorticoid therapy. Lessons: Due to the complex interplay between liver function and thyroid hormones, there may be unusual changes of thyroid function in GD patients with severe liver injury after TPE. By this case, we want to highlight the importance of a closely following up of thyroid function in order to deliver appropriate health suggestions for patients.

show abstract

Section: Introductionmentioning

confidence: 99%