Severe cholestatic jaundice in hyperthyroidism: a case report
Abstract
Introduction: Thyroid storm is an endocrinological emergency caused by an exacerbation of the hyperthyroid state and is characterised by multi organ dysfunction. Liver dysfunction or injury predominantly of a cholestatic type is one of the atypical manifestations of hyperthyroidism and has been previously described in literature.
Case report: We report a case of a 47 year old nonalcoholic male patient who presented with jaundice and weight loss due to hyperthyroidism complicated by cholestatic hepatic injury and hyperkalaemia.
Conclusion: This case highlights the varied multi organ dysfunctions seen in a patient with hyperthyroidism with emphasis on liver injury mainly to increase awareness among clinicians in resource limited settings. Mechanisms of liver injury due to thyroid storm or hyperthyroidism are discussed in the literature review.
References
2. Sarlis JN, Gourgiotis. Thyroid Emergencies. Rev End Metab Dis. 2003;4:129–136. doi: 10.1023/A:1022933918182.
3. Hull K, Horenstein R, Naglieri R, Munir K, Ghany M, Celi FS. Two cases of thyroid storm–associated cholestatic jaundice. Endocr Pract. 2007;13:476–480.
4. Malik R, Hodgson H. The relationship between the thyroid gland and the liver. Q J Med. 2002;95:559–569. doi: 10.1093/ qjmed/95.9.559
5. Boelaert K, Newby PR, Simmonds MJ. et al. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. Am J Med. 2010;123:183. e1–183.e9. doi: 10.1016/j.amjmed.2009.06.030
6. Czaja AJ, Carpenter HA, Santrach PJ, Moore SB. Genetic predispositions for the immunological features of chronic active hepatitis. Hepatology. 1993;18:816–822. doi: 10.1002/ hep.1840180411
7. Myers RP, Cerini R, Sayegh R. et al. Cardiac hepatopathy: clinical, hemodynamic and histologic characteristics and correlations. Hepatology. 2003;37:393–400. doi: 10.1053/ jhep.2003.50062
8. Giallourakis CC, Rosenberg PM, Friedman LS. The liver in heart failure. Clin Liver Dis. 2002;6:947–967. doi: 10.1016/ S1089-3261(02)00056-9.
9. Williams KV, Nayak S, Becker D, Reyes J, Burmeister LA. Fifty years of experience with propylthiouracil-associated hepatotoxicity: what have we learned? J Clin Endocrinol Metab. 1997; 82:1727–33. doi: 10.1210/jc.82.6.1727.
