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Lactate dehydrogenase (LDH)-linked immunoglobulin in a patient with Graves' disease treated with methimazole
1Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
Insights
This case study identifies a potential autoantibody to lactate dehydrogenase (LDH) in a patient with Graves' disease treated with methimazole. The antibody may contribute to drug-induced liver injury and persistent high LDH levels.
Area of Science:
- Endocrinology
- Hepatology
- Immunology
Background:
- Graves' disease is an autoimmune disorder often treated with methimazole.
- Methimazole can rarely cause drug-induced liver injury.
- Autoimmune conditions can lead to complex immune responses.
Observation:
- A 26-year-old woman on methimazole for Graves' disease developed elevated liver enzymes and lactate dehydrogenase (LDH).
- While liver enzymes normalized, LDH remained high with abnormal isoenzyme patterns.
- Immunoglobulin G (IgG) was found to be linked to LDH.
Findings:
- The study suggests the presence of an autoantibody to LDH, characterized by IgG binding.
- This autoantibody is hypothesized to be a result of the interplay between autoimmunity, methimazole treatment, and hepatic disorder.
- The findings indicate a potential mechanism for persistent high LDH levels in this patient.
Implications:
- This case highlights a potential immunologic complication of methimazole therapy in Graves' disease.
- The identification of an LDH autoantibody may improve understanding of drug-induced liver injury.
- Further research is warranted to confirm the role of LDH autoantibodies in hepatic disorders.
Abstract:
A 26-year-old woman who received methimazole treatment for Graves' disease is discussed. Two months following treatment, her serum GOT level rose to 45 K.U, her GPT to 60 K.U, and her lactate dehydrogenase (LDH) to 645 W.U; a hepatic disorder was then suspected. Later, the serum GOT and GPT concentrations decreased to a normal range, but her serum LDH continued to maintain a high level. An LDH isoenzyme analysis showed an abnormally broad LDH. The IgG that was linked to the LDH is suspected to have been the result of her underlying autoimmunity, the methimazole treatment, and the development of her hepatic disorder. Thus, this IgG was thought to be the autoantibody to LDH.