严重的肝功能障碍在甲状腺毒性治疗后48小时内:一个病例报告
Christopher Annabi1, Laila Noor2, Jamie A Mullally2
1School of Medicine, New York Medical College, Valhalla, NY, USA.
The American journal of case reports
|September 30, 2025
概括
这份病例报告强调了在开始治疗甲状腺功能增强症时服用胺胺 (甲基马,甲) 的48小时内出现的快速肝衰竭. 同时感染SARS-CoV-2可能是导致的因素.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 胺胺 (甲基马,甲) 是高甲状腺症的标准治疗方法.
- 虽然很少见,但蒂奥纳米德的使用与严重的肝损伤有关,包括肝衰竭.
- 胺胺诱导的肝损伤的典型发作通常是在启动后的几周到几个月.
研究的目的:
- 报告一种罕见的 fulminant 肝衰竭病例,在 thionamide 开始后迅速发生.
- 调查加速肝损伤的潜在因素.
主要方法:
- 一个中年妇女患有格雷夫斯病和SARS-CoV-2感染的病例报告.
- 开始高剂量甲基马,然后切换到甲.
- 监测肝功能测试,肝活检和支持性护理.
主要成果:
- 胺胺开始治疗后48小时内发生的充血性肝功能衰竭.
- 肝脏活检证实了药物诱导的肝损伤.
- 患者在停止治疗和支持性治疗后完全康复.
结论:
- 这一案例表明,胺胺诱导的肝损伤的时间框架比以前报告的要短得多.
- 高剂量 thionamide 暴露,SARS-CoV-2 感染和 remdesivir 治疗可能是快速肝衰竭的危险因素.
相关概念视频
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
185
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
185
Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
256
Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
256
Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
214
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
214
Therapeutic Drug Monitoring: Affecting Factors
201
Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
201
Therapeutic Drug Monitoring: Drug Analysis Methods
179
Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood or body tissues to tailor drug therapy effectively. This monitoring is critical for managing drugs with narrow therapeutic indices like digoxin and phenytoin, ensuring they are both safe and effective. For instance, monitoring theophylline levels in asthma patients involves precision and sensitivity to adjust doses according to individual responses to therapy, ensuring efficacy and...
179
Effect of Hepatic Disease on Pharmacokinetics: Active Drug, Metabolite and Fraction of Metabolized Drug
215
In pharmacotherapy, monitoring drug concentrations is paramount, especially for drugs whose therapeutic effects hinge on both the active compound and its metabolite. Hepatic impairment profoundly influences drug potency by altering liver function. If the drug is more potent than its metabolite, impaired liver function amplifies drug activity due to elevated drug concentration levels. Conversely, if the metabolite holds greater potency, diminished liver function diminishes drug activity by...
215


