Department of Hepatology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
Clinical Medical School, Peking University, Beijing, China.
Scand J Gastroenterol. 2023 Jul-Dec;58(12):1514-1522. doi: 10.1080/00365521.2023.2244107. Epub 2023 Aug 7.
Graves' hyperthyroidism (GH) is often accompanied by mild to moderate liver injury, but severe hepatic dysfunction (SHD) is relatively rare. Whether patients with GH-related SHD can be treated with methimazole (MMI) remains controversial. This study aimed to determine the clinical characteristics and to evaluate the role of low-dose MMI for such patients.
33 patients with GH-related SHD were selected for this retrospective study in the Fifth Medical Center of Chinese PLA General Hospital from January 2017 to July 2022. The clinical manifestations, therapeutic responses, and effectiveness of MMI were evaluated.
Systemic jaundice (100.0%), yellow urine (100.0%), fatigue (87.9%), and goiter (66.7%) were the main symptoms. Total bilirubin (TBIL) had no linear correlation with free triiodothyronine (FT) ( = -0.023, = .899), free thyroxine (FT) ( = 0.111, = .540), T ( = -0.144, = .425), and T ( = 0.037, = .837). On the 14th day after admission, FT, FT, T, T, TBIL, direct bilirubin (DBIL), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), and international normalized ratio (INR) decreased compared with the baseline ( < .05). The decrease rates of FT, FT, T, T, TBIL, and DBIL in the MMI group were higher than those in the non-MMI group ( < .05). The improvement rate of the MMI group (77.8%) was higher than that of the non-MMI group (9.5%, = .001). MMI treatment is an independent predictor affecting the early improvement of patients (OR = 0.022, = .010).
The main clinical manifestations of patients with GH-related SHD were symptoms related to liver disease. Low-dose MMI was safe and effective for them.
格雷夫斯甲亢（GH）常伴有轻至中度肝损伤，但严重肝功能不全（SHD）较为少见。对于 GH 相关 SHD 患者，能否采用甲巯咪唑（MMI）治疗仍存在争议。本研究旨在明确此类患者的临床特征，并评估小剂量 MMI 的作用。
回顾性分析 2017 年 1 月至 2022 年 7 月解放军总医院第五医学中心收治的 33 例 GH 相关 SHD 患者的临床资料，评估其临床表现、治疗反应及 MMI 疗效。
全身黄疸（100.0%）、尿色黄（100.0%）、乏力（87.9%）、甲状腺肿（66.7%）是主要表现。总胆红素（TBIL）与游离三碘甲状腺原氨酸（FT）（ = -0.023， = .899）、游离甲状腺素（FT）（ = 0.111， = .540）、T（ = -0.144， = .425）、T（ = 0.037， = .837）无线性相关。入院第 14 天，FT、FT、T、T、TBIL、直接胆红素（DBIL）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）、国际标准化比值（INR）较基线均下降（ < .05）。与非 MMI 组相比，MMI 组 FT、FT、T、T、TBIL、DBIL 下降幅度更大（ < .05）。MMI 组改善率（77.8%）高于非 MMI 组（9.5%， = .001）。MMI 治疗是影响患者早期改善的独立预测因素（OR = 0.022， = .010）。
GH 相关 SHD 患者的主要临床表现为肝脏疾病相关症状，小剂量 MMI 治疗安全有效。
