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Liver Dysfunction in a Patient with Graves' Disease.

Filipa Campos1, Angelica Sharma1, Bijal Patel1

  • 1Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK.

Journal of Clinical Medicine
|November 27, 2024
PubMed
Summary

Thyrotoxicosis can cause liver dysfunction, and antithyroid drugs like carbimazole may worsen it. Promptly stopping carbimazole and initiating radioiodine therapy improved liver function in a Graves' disease patient.

Keywords:
Grave’s diseasecarbimazolehepatitishyperthyroidismliver dysfunction

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Area of Science:

  • Endocrinology
  • Hepatology
  • Internal Medicine

Background:

  • Liver dysfunction is a recognized complication in patients with thyrotoxicosis.
  • Graves' disease (GD) is a common cause of hyperthyroidism, often associated with various clinical manifestations.
  • The interplay between thyroid dysfunction, its treatment, and liver health requires careful consideration.

Purpose of the Study:

  • To explore the potential causes of liver dysfunction in hyperthyroid patients.
  • To analyze the specific case of a patient with Graves' disease experiencing worsening liver dysfunction after carbimazole initiation.
  • To review literature on thyrotoxicosis-induced liver dysfunction, antithyroid drug-related liver injury, and exacerbation of pre-existing liver conditions.

Main Methods:

  • Case report analysis of a 42-year-old male with Graves' disease and hyperthyroidism.
  • Monitoring of liver function tests (ALT, fT4, fT3, TSH) and thyroid-stimulating hormone receptor antibody (TRAb) levels.
  • Literature review on the aetiologies of liver dysfunction in hyperthyroidism.

Main Results:

  • The patient presented with mild liver dysfunction (ALT 65 IU/L) and hyperthyroidism (Graves' disease).
  • Carbimazole (CBZ) treatment led to worsening liver dysfunction (ALT peak 263 IU/L), a 'hepatitic' pattern, atypical for thionamide-induced injury.
  • Discontinuation of CBZ and radioiodine therapy resulted in rapid improvement of liver function (ALT 74 IU/L within 1 week).

Conclusions:

  • Antithyroid drugs, specifically carbimazole, can precipitate or exacerbate liver dysfunction in hyperthyroid patients.
  • The pattern of liver injury (hepatitic vs. cholestatic) may vary, and prompt drug withdrawal is crucial.
  • Risk factors for liver dysfunction in Graves' disease include older age and higher TRAb titres, necessitating comprehensive patient evaluation.