格雷夫斯病中的胆汁淤积性肝炎：一项诊断挑战。

Cholestatic Hepatitis in Graves' Disease: A Diagnostic Challenge.

作者信息

Haddaden Metri, Hanna Angy, Odish Fadi, Husami Samir, Imam Zaid, Tahhan Mamon

机构信息

Department of Internal Medicine, MedStar Health, Baltimore, MD.

Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI.

出版信息

ACG Case Rep J. 2021 Jan 14;8(1):e00526. doi: 10.14309/crj.0000000000000526. eCollection 2021 Jan.

DOI:10.14309/crj.0000000000000526

PMID:33490298

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7810504/

Abstract

Cholestatic hepatitis is a rare presentation of thyrotoxicosis potentially confused as an adverse effect of antithyroid therapy. We report a 37-year-old man with cholestatic hepatitis as an initial presentation of Graves' disease. Diagnostic evaluation demonstrated (i) elevated transaminases and alkaline phosphatase (R-factor value: 2.6), and marked cholestasis (total bilirubin: 17.3 mg/dL, direct bilirubin: 9.4 mg/dL); (ii) negative hepatitis, viral, and autoimmune serologies; (iii) normal magnetic resonance cholangiopancreatography; (iv) liver biopsy with marked cholestasis and no fibrosis; (v) thyroid-stimulating hormone <0.01, fT4 (free thyroxine): 1.5, fT4 (free triiodothyronine): 4.3 and positive thyroid-stimulating immunoglobulins. Radioiodine uptake scan confirmed Graves' disease. Clinical resolution was achieved with propranolol, prednisone, methimazole, and thyroidectomy.

摘要

胆汁淤积性肝炎是甲状腺毒症的一种罕见表现，可能会被误诊为抗甲状腺治疗的不良反应。我们报告一名37岁男性，以胆汁淤积性肝炎作为格雷夫斯病的首发表现。诊断评估显示：（i）转氨酶和碱性磷酸酶升高（R因子值：2.6），且有明显胆汁淤积（总胆红素：17.3mg/dL，直接胆红素：9.4mg/dL）；（ii）肝炎、病毒及自身免疫血清学检查均为阴性；（iii）磁共振胰胆管造影正常；（iv）肝活检显示明显胆汁淤积且无纤维化；（v）促甲状腺激素<0.01，游离甲状腺素（fT4）：1.5，游离三碘甲状腺原氨酸（fT3）：4.3，甲状腺刺激免疫球蛋白阳性。放射性碘摄取扫描确诊为格雷夫斯病。通过普萘洛尔、泼尼松、甲巯咪唑及甲状腺切除术实现了临床缓解。