A case of thyroid storm complicated by acute hepatitis due to propylthiouracil treatment

Endocrinology, Diabetes & Metabolism Case Reports

article

Nicola Tufton¹  Nazhri Hashim¹  Candy Sze¹  Mona Waterhouse¹ 

[1] Bartshealth NHS Trust, St Bartholomew’s Hospital

关键词: Adult;    Female;    White;    United Kingdom;    Thyroid;    Thyroid;    Thyroxine (T4);    Triiodothyronine (T3);    TSH;    Thyroid storm;    Thyroid nodule;    Iatrogenic disorder;    Liver failure;    Pyrexia;    Tachycardia;    Free T4;    Total T3;    TSH;    Liver function;    Ultrasound scan;    Thyroid scintigraphy;    Radionuclide therapy;    Prednisolone;    Glucocorticoids;    Propylthiouracil;    Propranolol;    Beta-blocker;    Paracetamol;    Hepatology;    Unusual effects of medical treatment;    August;    2015;   

DOI  :  10.1530/EDM-15-0052

学科分类：血液学

来源: Bioscientifica Ltd.

【 摘 要 】

A 57-year-old female presented 17 days after treatment with radioactive iodine (RAI) for difficult-to-controlhyperthyroidism. She was febrile, had a sinus tachycardia, and was clinically thyrotoxic. Her thyroid function tests showeda suppressed TSH !0.02 mU/l, with free thyroxine (FT4) O75 pmol/l and total triiodothyronine (TT3) 6.0 nmol/l. She wasdiagnosed with thyroid storm and was managed with i.v. fluids, propylthiouracil (PTU) 200 mg four times a day, prednisolone30 mg once daily and propanolol 10 mg three times a day. She gradually improved over 2 weeks and was discharged home onPTU with b blockade. On clinic review 10 days later, it was noted that, although she was starting to feel better, she had grosslyabnormal liver function (alanine transaminase (ALT) 852 U/l, bilirubin 46 mmol/l, alkaline phosphatase (ALP) 303 U/l,international normalized ratio (INR) 0.9, platelets 195!109/l). She was still mildly thyrotoxic (TSH !0.02 mU/l, FT4 31 pmol/l,TT3 1.3 nmol/l). She was diagnosed with acute hepatitis secondary to treatment with PTU. Ultrasound showed mildhepatic steatosis. PTU was stopped and she was managed with fluids and prednisolone 60 mg once daily and continuedb blockade. Her liver function gradually improved over 10 days (bilirubin 9 mmol/l, ALT 164 U/l, ALP 195 U/l, INR 0.9,platelets 323!109/l) with conservative management and had normalised by clinic review 3 weeks later. This case highlightsthe potentially fatal, but rare, complications associated with both RAI and PTU, namely, thyroid storm and acutehepatitis respectively.

【 授权许可】

CC BY-NC-ND