Propylthiouracil-induced liver failure and artificial liver support systems: a case report and review of the literature

Abstract

BackgroundAntithyroid drugs carry a potential risk of hepatotoxicity. Propylthiouracil (PTU) is commonly prescribed for patients with hyperthyroidism. PTU, however, can induce liver injury, ranging from mild asymptomatic elevation of aminotransferases to acute liver failure (ALF).Case presentationThis case reports on a 16-year-old Chinese girl with hyperthyroidism, who was admitted to our hospital for jaundice, nausea, and fatigue associated with severe hyperbilirubinemia and coagulopathy. She had been prescribed PTU 5 months earlier. There was no history of hypersensitivity to drugs, viral liver diseases, blood transfusion, or surgery. On the basis of her symptoms and the clinical data, she was diagnosed with PTU-induced ALF. Due to the limited number of available donor organs for liver transplantation, she was started on treatment with artificial liver support system (ALSS). After four sessions of ALSS, her clinical signs and symptoms were found to be markedly improved, and she was discharged 25 days after admission. Four months later, her liver function normalized.ConclusionAlthough PTU-induced liver failure is rare in clinical practice, liver function should be appropriately monitored during treatment with PTU. PTU-induced ALF in this patient was successfully managed with an ALSS, suggesting that the latter may be an alternative to liver transplantation.

Challenges in early identification of causes and treatment of cholestasis in patients with hyperthyroidism: a case report and literature review

“…An artificial liver support system has also been found to be effective in treating patients with ATD-induced cholestasis by decreasing thyroid hormone and bilirubin levels and promoting recovery of liver injury. 54 In conclusion, distinguishing between thyrotoxicosis-and MMI-induced severe cholestasis is difficult. Discontinuing MMI, treatment with glucocorticoids, and control of hyperthyroidism with radioactive iodine may be effective treatment methods for severe cholestasis induced by thyrotoxicosis or MMI in patients with hyperthyroidism.…”

“…An artificial liver support system has also been found to be effective in treating patients with ATD-induced cholestasis by decreasing thyroid hormone and bilirubin levels and promoting recovery of liver injury. 54 …”

Serum Lactate: Creatinine Ratio as a Prognostic Marker for Liver Failure Patients Treated by artificial liver support systems

“…Liver failure develops rapidly and leads to high short-term mortality. Studies [6,[28][29][30] have shown that ALSSs therapy can remove harmful substances from the body, maintain homeostasis, temporarily assist or replace liver function, facilitate hepatocyte regeneration and recovery of liver function, and improve the survival rate of patients with liver failure. Hu P. [11] found that levels of ALB, creatinine, TBIL, INR, PTA, and ALT in serum changed signi cantly before and after ALSSs treatment.…”

Drug-Induced Liver Injury: A Unique Presentation of Single-Dose Administration of Propylthiouracil

“… 1 , 6 - 10 While cases of PTU-induced DILI have been described in the biomedical literature, the present case was notable for the rapidity with which liver dysfunction occurred—as after just a single dose of PTU a severe elevation in the transaminases ensued. 11 …”