Fulminant hepatitis and elevated levels of sIL-2R in thyroid storm

Abstract

Summary We report the case of a 48-year-old man with thyroid storm associated with fulminant hepatitis and elevated levels of soluble interleukin-2 receptor (sIL-2R). Fatigue, low-grade fever, shortness of breath, and weight loss developed over several months. The patient was admitted to the hospital because of tachycardia-induced heart failure and liver dysfunction. Graves’ disease with heart failure was diagnosed. He was treated with methimazole, inorganic iodide, and a β-blocker. On the day after admission, he became unconscious with a high fever and was transferred to the intensive care unit. Cardiogenic shock with atrial flutter was treated with intra-aortic balloon pumping and cardioversion. Hyperthyroidism decreased over 10 days, but hepatic failure developed. He was diagnosed with thyroid storm accompanied by fulminant hepatitis. Laboratory investigations revealed elevated levels of sIL-2R (9770 U/mL). The fulminant hepatitis was refractory to plasma exchange and plasma filtration with dialysis, and no donors for liver transplantation were available. He died of hemoperitoneum and gastrointestinal hemorrhage due to fulminant hepatitis 62 days after admission. Elevated circulating levels of sIL-2R might be a marker of poor prognosis in thyroid storm with fulminant hepatitis. Learning points: The prognosis of thyroid storm when fulminant hepatitis occurs is poor. Liver transplantation is the preferred treatment for fulminant hepatitis induced by thyroid storm refractory to plasma exchange. Elevated levels of soluble interleukin-2 receptor might be a marker of poor prognosis in patients with thyroid storm.

Severe hyperthyroidism without symptoms due to nonthyroidal illness in a child with acute hepatitis: case report and literature review

“…Although there are multiple case reports of cholestasis and severe liver dysfunction presenting in patients with hyperthyroidism, these are mainly adult patients, many of whom have associated comorbid conditions 33–35,46–49 . Additional causes for the liver dysfunction in these patients may include concomitant autoimmune liver disease, drug‐induced dysfunction from antithyroid medication, and/or sepsis 49 .…”

Thyroid Storm Presenting as Acute Liver Failure in a Patient with Graves’ Disease

“…The existing literature on ALF secondary to thyroid storm is limited to a few case reports. Almost 15% to 76% of patients with untreated hyperthyroidism present with mildly elevated LFTs, ALF in this group of patients is extremely uncommon [1,[5][6][7][8][9]. The exact mechanism of ALF in thyroid storm is still controversial.…”

Apathetic Thyroid Storm with Cardiorespiratory Failure, Pulmonary Embolism, and Coagulopathy in a Young Male with Graves’ Disease and Myopathy

“…Deranged liver function tests in thyroid storm could be due to multiple mechanisms including heart failure-induced congestive hepatomegaly [ 27 ], peripheral vasodilatation-induced hepatic ischaemia [ 27 ], thyrotoxicosis-induced direct hepatocyte toxicity [ 27 ], concomitant autoimmune hepatic diseases (autoimmune hepatitis and primary biliary cirrhosis) [ 27 ], or effect of antithyroid drugs [ 28 ]. Hyperthyroidism as the cause of deranged liver function can only be considered after all those aetiologies are ruled out [ 29 …”

“…Congestive hepatomegaly is associated with moderate (2- or 3-fold) transaminase levels with bilirubin levels that are rarely >50 μ mol/L, whereas ischaemic hepatitis is associated with extremely high bilirubin (∼250 μ mol/L) and transaminase (>10-fold) levels [ 30 ]. Fulminant hepatitis is a rare, life-threatening complication of thyroid storm associated with multiorgan failure and poor prognosis [ 27 ]. Orthotopic liver transplantation is the treatment of choice for thyroid storm-associated fulminant hepatitis [ 27 ].…”

“…Fulminant hepatitis is a rare, life-threatening complication of thyroid storm associated with multiorgan failure and poor prognosis [ 27 ]. Orthotopic liver transplantation is the treatment of choice for thyroid storm-associated fulminant hepatitis [ 27 ].…”