Sato Ikuko, Tsunekawa Taku, Shinohara Yuri, Nishio Yuichiro, Shimizu Yuko, Suzuki Yasuhiko, Yoshioka Shuko
Department of Endocrinology and Diabetes, Tosei General Hospital, Japan.
Nagoya J Med Sci. 2011 Aug;73(3-4):205-9.
A 58-year-old woman was referred to our hospital because of liver dysfunction. Her serum levels of AST (619 IU/l) and ALT (603 IU/l) had increased. Histological findings in the liver biopsy were compatible to autoimmune hepatitis (AIH), and the diagnosis of AIH was confirmed by the diagnostic criteria. She was admitted to a nearby hospital 3 years ago, and diagnosed with Graves' disease. She received methimazole (MMI) at first, which was discontinued due to liver injury in one month, then propylthiouracil (PTU) was administered. One year later, transaminase increased and was decreased by stopping PTU administration. PTU was restarted after her transaminase decreased, but a recurrence of hepatotoxicity was observed, and she was referred to our hospital. Oral prednisolone decreased liver function immediately. In this case, PTU-induced liver injury was suspected as a possible trigger of AIH. While PTU remains a commonly used drug in the treatment of hyperthyroidism, severe liver injury is reported in some cases. If liver injury is observed in patients treated with PTU, rechallenge is not recommended in order to avoid severe hepatotoxicity.
一名58岁女性因肝功能不全转诊至我院。她的血清谷草转氨酶（AST，619 IU/L）和谷丙转氨酶（ALT，603 IU/L）水平升高。肝脏活检的组织学结果符合自身免疫性肝炎（AIH），根据诊断标准确诊为AIH。她3年前因格雷夫斯病入住附近医院，起初接受甲巯咪唑（MMI）治疗，1个月后因肝损伤停药，随后给予丙硫氧嘧啶（PTU）。1年后，转氨酶升高，停用PTU后下降。转氨酶下降后重新开始使用PTU，但再次出现肝毒性，遂转诊至我院。口服泼尼松龙后肝功能立即改善。该病例中，怀疑PTU诱导的肝损伤可能是AIH的触发因素。虽然PTU仍是治疗甲状腺功能亢进症的常用药物，但有报道称在某些情况下会导致严重肝损伤。如果PTU治疗的患者出现肝损伤，为避免严重肝毒性，不建议再次使用。
