Wafa Benothman, Faten Hadjkacem, Mouna Elleuch, Fatma Mnif, Mohamed Abid
Department of Endocrinology Hedi Chaker Hospital Sfax Tunisia.
JGH Open. 2020 Apr 11;4(5):876-879. doi: 10.1002/jgh3.12337. eCollection 2020 Oct.
Hyperthyroidism has been known to be associated with abnormalities of serum liver chemistry. The objective of our study is to describe clinical, biochemical and therapeutic features of hepatic dysfunction in hyperthyroidism.
This retrospective study was conducted on patients hospitalized in our endocrinology department over 20 years. We included patients with untreated and noniatrogenic hyperthyroidism among whom biochemical findings noted hepatic dysfunction and excluded those with concomitant liver disease. Our population is composed of 10 men and 7 women. The average age was 41.4 years. The mean serum level of free thyroxine was 83.8 pmol/L. The serum thyrotropin level was below the detection limit in 10/17 cases. Graves' disease was the most frequently found etiology of hyperthyroidism. Fourteen patients had hyperthyroidism's complications. Eleven patients manifested congestive heart failure. Hepatic dysfunction was moderate and severe in eight and two cases, respectively. Fifteen patients had cholestasis, associated with jaundice in five cases. Hepatocellular injury and synthetic liver dysfunction were noted in seven and five cases, respectively. Thyroid peroxidase antibodies were positively correlated with the serum level of bilirubin ( = 0.695; = 0.038). A negative correlation was noted between alanine aminotransferase and left ventricular ejection fraction ( = -0.812; = 0.05). Radioactive iodine was indicated in 15/17 cases. Follow-up liver tests were performed in 11 cases. They all had normalized hepatic function once euthyroidism restored.
Liver injury in hyperthyroidism is relatively common, ranging from mild to severe. Therefore, patients presenting unexplained hepatic abnormalities require close examination and an evaluation of the thyroid function should be sought.
已知甲状腺功能亢进与血清肝功能异常有关。我们研究的目的是描述甲状腺功能亢进症患者肝功能障碍的临床、生化和治疗特征。
本回顾性研究对我院内分泌科20余年来收治的患者进行。我们纳入了未经治疗且非医源性甲状腺功能亢进的患者，这些患者的生化检查结果显示存在肝功能障碍，同时排除了合并肝脏疾病的患者。我们的研究对象包括10名男性和7名女性。平均年龄为41.4岁。游离甲状腺素的平均血清水平为83.8 pmol/L。17例中有10例血清促甲状腺素水平低于检测限。格雷夫斯病是最常见的甲状腺功能亢进病因。14例患者有甲状腺功能亢进症的并发症。11例患者出现充血性心力衰竭。肝功能障碍分别为中度8例和重度2例。15例患者出现胆汁淤积，其中5例伴有黄疸。分别有7例和5例出现肝细胞损伤和肝脏合成功能障碍。甲状腺过氧化物酶抗体与血清胆红素水平呈正相关（r = 0.695；P = 0.038）。丙氨酸氨基转移酶与左心室射血分数呈负相关（r = -0.812；P = 0.05）。17例中有15例采用放射性碘治疗。11例患者进行了肝功能随访检查。甲状腺功能恢复正常后，他们的肝功能均恢复正常。
甲状腺功能亢进症患者的肝损伤较为常见，程度从轻到重不等。因此，出现不明原因肝脏异常的患者需要仔细检查，并应评估甲状腺功能。
