Wu Dong-Bo, Chen En-Qiang, Bai Lang, Tang Hong
Center of Infectious Diseases, West China Hospital of Sichuan University; Division of Molecular Biology of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, People's Republic of China.
Ther Clin Risk Manag. 2017 Jan 11;13:65-68. doi: 10.2147/TCRM.S122611. eCollection 2017.
Antithyroid drugs carry a potential risk of hepatotoxicity. Propylthiouracil (PTU) is commonly prescribed for patients with hyperthyroidism. PTU, however, can induce liver injury, ranging from mild asymptomatic elevation of aminotransferases to acute liver failure (ALF).
This case reports on a 16-year-old Chinese girl with hyperthyroidism, who was admitted to our hospital for jaundice, nausea, and fatigue associated with severe hyperbilirubinemia and coagulopathy. She had been prescribed PTU 5 months earlier. There was no history of hypersensitivity to drugs, viral liver diseases, blood transfusion, or surgery. On the basis of her symptoms and the clinical data, she was diagnosed with PTU-induced ALF. Due to the limited number of available donor organs for liver transplantation, she was started on treatment with artificial liver support system (ALSS). After four sessions of ALSS, her clinical signs and symptoms were found to be markedly improved, and she was discharged 25 days after admission. Four months later, her liver function normalized.
Although PTU-induced liver failure is rare in clinical practice, liver function should be appropriately monitored during treatment with PTU. PTU-induced ALF in this patient was successfully managed with an ALSS, suggesting that the latter may be an alternative to liver transplantation.
抗甲状腺药物存在肝毒性风险。丙硫氧嘧啶（PTU）常用于治疗甲状腺功能亢进症患者。然而，PTU可导致肝损伤，从轻度无症状转氨酶升高到急性肝衰竭（ALF）不等。
本病例报告了一名16岁的中国甲状腺功能亢进症女孩，因黄疸、恶心和疲劳伴严重高胆红素血症及凝血功能障碍入院。她在5个月前开始服用PTU。无药物过敏史、病毒性肝病、输血或手术史。根据其症状和临床资料，诊断为PTU所致ALF。由于肝移植可用供体器官数量有限，开始对她进行人工肝支持系统（ALSS）治疗。经过4次ALSS治疗后，发现其临床体征和症状明显改善，入院25天后出院。4个月后，其肝功能恢复正常。
虽然PTU所致肝衰竭在临床实践中较为罕见，但在PTU治疗期间应适当监测肝功能。该患者的PTU所致ALF通过ALSS成功治疗，提示ALSS可能是肝移植的替代方法。
