Liver dysfunction associated with hyperthyroidism: Lessons from 2 Case reports

Opoku-Akyeampong, Nana Akua; Agyei-Nkansah, Adwoa; Yorke, Ernest

doi:10.1002/ccr3.4067

Cited by 7 publications

(12 citation statements)

References 14 publications

(34 reference statements)

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“…Moreover, severe LD is a rare but potentially lethal complication of GD, and its treatment is clinically important. Only a few cases of GD with severe LD have been reported to date ( 6 , 7 ), and there is no clear guidance or expert consensus regarding the management of this clinical condition.…”

Section: Introductionmentioning

confidence: 99%

Effect of 131I with and without artificial liver support system in patients with Graves’ disease and severe liver dysfunction: A retrospective study

Rao

Wang²,

Ren³

et al. 2022

Front. Endocrinol.

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ObjectiveTreatment 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.MethodsIn 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.ResultsThyroid 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).ConclusionThe 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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Section: Introductionmentioning

confidence: 99%

Effect of 131I with and without artificial liver support system in patients with Graves’ disease and severe liver dysfunction: A retrospective study

Rao

Wang²,

Ren³

et al. 2022

Front. Endocrinol.

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“…(1) direct liver toxicity from exposure of excess thyroid hormones; (2) liver cell degeneration from accelerated decomposition of liver glycogen and protein; (3) congestive hepatopathy from thyrotoxic heart failure; (4) previous underlying liver disease; (5) toxicity and injury by antithyroid medications; (6) autoimmune-related liver injury. 5,6 Retrospective studies also reported that the risk factors of liver dysfunction were age, course of Graves' disesase, heart rate, weight of the thyroid gland, FT4 level, TR-antibodies, and TPO-antibodies. 7 Congestive hepatopathy is described as manifestations of chronic, passive congestion of the liver in the setting of heart failure or other cardiac defects that result in elevation of central venous pressure.…”

Section: Discussionmentioning

confidence: 99%

Congestive hepatopathy secondary to graves’ disease: a case report

Adrian¹,

Wirawan²

2022

Int J Adv Med

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Graves’ disease is a common cause of hyperthyroidism in iodine-sufficient parts of the world. Excessive thyroid hormone is known to have multiple effects on various organs, including the liver. We reported a case of 49-year old male patient with worsening jaundice, ascites, tremor, and palpitation, with previous history of uncontrolled Graves’ disease. Findings from examination reveals signs of congestive hepatopathy, such as positive hepatojugular reflux and dilated hepatic vein. Treatment options for hyperthyroidism in patients with liver dysfunction includes methimazole and radioactive iodine-131. Liver dysfunction in patients with thyrotoxicosis is commonly found in daily practice, but establishing the cause of liver dysfunction can be a challenge because of the multiple cause of liver injury in hyperthyroidism.

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“…Several mechanisms contribute to liver dysfunction in a state of thyrotoxicosis. These include: 1) direct liver toxicity caused by prolonged exposure to excessive thyroid hormone production, 2) hepatocyte anoxia as a result of the hypermetabolic state, 3) metabolic dysfunction due to liver glycogen and protein decomposition, 4) autoimmune-related liver injury, 5) drugs such as antithyroid medications induced liver injury, and 6) hepatic congestion and hepatic necrosis from thyrotoxic heart failure [16][17][18][19][20][21]. However, because liver dysfunction in Case 2 was too severe to be explained solely by thyrotoxicosis, we speculated that the vaccine might have affected his liver function.…”

Section: Discussionmentioning

confidence: 99%

Subacute thyroiditis with liver dysfunction following coronavirus disease 2019 (COVID-19) vaccination: report of two cases and a literature review

2022

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Subacute thyroiditis is a transient inflammatory thyroid disease characterized by neck pain, fever, and typical symptoms associated with thyrotoxicosis. The incidence of subacute thyroiditis is higher in female than in male, and susceptibility is prominent in the 30-50-year age range. The variety of case reports on subacute thyroiditis associated with coronavirus disease 2019 (COVID-19) appears to be increasing, and subacute thyroiditis following COVID-19 vaccination has recently been reported. Herein, we report two cases of subacute thyroiditis that developed after receiving the COVID-19 mRNA vaccine, one of which exhibited remarkable liver dysfunction. The mechanism underlying the development of postvaccination subacute thyroiditis remains unknown; however, one theory suggests that adjuvants contained in vaccines may play a role in triggering diverse autoimmune and inflammatory responses. Another possibility is the potential cross-reactivity between the coronavirus spike protein target produced by the mRNA vaccine and thyroid cell antigens. Common side effects of the COVID-19 vaccine include pain at the injection site, fever, fatigue, headache, muscle pain, chills, and nausea. These symptoms are usually resolved within a few days. Subacute thyroiditis may present symptoms similar to those of short-term vaccination side effects or exhibit non-specific symptoms, potentially leading to misdiagnosis or underdiagnosis. Therefore, clinicians should be aware of the possible development of subacute thyroiditis after COVID-19 vaccination.

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Liver dysfunction associated with hyperthyroidism: Lessons from 2 Case reports

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.

Cited by 7 publications

References 14 publications

Effect of 131I with and without artificial liver support system in patients with Graves’ disease and severe liver dysfunction: A retrospective study

Effect of 131I with and without artificial liver support system in patients with Graves’ disease and severe liver dysfunction: A retrospective study

Congestive hepatopathy secondary to graves’ disease: a case report

Subacute thyroiditis with liver dysfunction following coronavirus disease 2019 (COVID-19) vaccination: report of two cases and a literature review

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