Hasan Muhammad K, Tierney William M, Baker Mary Zoe
Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA.
Am J Med Sci. 2004 Dec;328(6):348-50. doi: 10.1016/s0002-9629(15)33945-8.
A 39-year-old white man was referred to our hospital for evaluation of his jaundice and pruritus. The patient was treated with I for diffuse toxic goiter prior to his referral to our hospital. Clinical examination and laboratory investigations excluded viral hepatitis, autoimmune hepatitis, granulomatous disease, primary biliary disease, extrahepatic biliary obstruction, and heart failure. Liver biopsy showed severe intrahepatic and canalicular cholestasis with minimal inflammatory changes. The patient's jaundice promptly resolved with therapy for hyperthyroidism and thyroid storm as bilirubin levels decreased from 35 mg/dL (normal: 0.5-1.2 mg/dL) to 0.4 mg/dL. Thyrotoxicosis can be an uncommon cause of profound cholestasis. Our case differs from all other reports in the literature because of the severity of the cholestasis and its prompt resolution with treatment for thyrotoxicosis.
一名39岁的白人男性因黄疸和瘙痒被转诊至我院。该患者在转诊至我院之前因弥漫性毒性甲状腺肿接受了碘治疗。临床检查和实验室检查排除了病毒性肝炎、自身免疫性肝炎、肉芽肿性疾病、原发性胆汁性疾病、肝外胆管梗阻和心力衰竭。肝活检显示严重的肝内和胆小管胆汁淤积，炎症变化轻微。随着甲状腺功能亢进和甲状腺危象的治疗，患者的黄疸迅速消退，胆红素水平从35mg/dL（正常：0.5-1.2mg/dL）降至0.4mg/dL。甲状腺毒症可能是严重胆汁淤积的罕见原因。我们的病例与文献中所有其他报告不同，因为胆汁淤积的严重程度以及甲状腺毒症治疗后迅速消退。
