Abstract
Thyrotoxicosis is a known cause of nonspecific abnormalities in liver function tests: most commonly mild elevations in serum bilirubin and liver enzymes, and rarely decreases in serum albumin levels. We report a case of severe hyperbilirubinemia and hypoalbuminemia secondary to thyrotoxicosis in a 64-year-old woman who presented to our emergency department with complaints of jaundice, pruritis, and chronic diarrhea. In our case, the symptoms and signs of various abnormalities in liver function tests such as serum albumin and bilirubin normalized after euthyroid state. We think that these findings are related to thyroid dysfunction. Every hyperbilirubinemia and hypoalbuminemia, which can be seen in many serious diseases, may unexpectedly appear in the long-term progression of thyrotoxicosis. Whether thyrotoxicosis is present in patients with hyperbilirubinemia and hypoalbuminemia should be evaluated.
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Ekpebegh CO, Levitt NS. A 40-year-old woman who developed jaundice during therapy for thyrotoxicosis. PLoS Med 2006; 3:e12.
Cooper DS, Rivkees SA. Putting propylthiouracil in perspective. J Clin Endocrinol Metab 2009; 94:1881–1882.
Kaplan MM, Gershwin ME. Primary biliary cirrhosis. N Engl J Med 2005; 353:1261–1273.
Malik R, Hodgson H. The relationship between the thyroid gland and the liver. QJM 2002; 95:559–569.
Bal C, Chawla M. Hyperthyroidism and jaundice. Indian J Nucl Med 2010; 25:131–134.
Raab W, Terplan C. Morbus Basedowii with subacute liver atrophy. Med Klin 1923; 19:1154.
Kerr WJ, Rusk GY. Acute yellow atrophy associated with hyperthyroidism. Med Clin North Am 1922; 6:445.
Zeldenrust J, Van Beek CC. Morphologic and experimental contribution to the pathogenesis of hepatic changes in exophthalmic goiter. Neder Tijdschr Geneesk; 1939; 103:568.
Beaver DC, Pemberton JDEJ. The pathologic anatomy of the liver in exophthalmic goiter. Ann Intern Med 1933 7:687.
Haban G. On liver changes in Graves’ disease, with special attention to liver cirrhosis. Beitr z path Anat uz allg Path 1933; 92:88.
Rössle R. On the changes of the liver in Basedow’s disease and its significance for the development of other organslerosis. Virchows Arch 1933; 291:1.
Cameron GR, Karunaratne WAE. Liver changes in exophthalmic goitre. J Pathol 1935; 41:267–282.
Sola J, Pardo-Mindan FJ, Zozaya J, Quiroga J, Sangro B, Prieto J. Liver changes in patients with hyperthyroidism. Liver 1991; 11: 193–197.
Marine D, Lenhart CH. Pathological anatomy of exophthalmic goiter: the anatomical and physiological relations of the thyroid gland to the disease; the treatment. Arch Intern Med 1911; 8:265–316.
Moschcowitz E. Pathogenesis of cirrhosis of the liver occurring in patients with diffuse toxic goiter. Arch Intern Med 1946; 78:497–530.
Piper J, Paulsen E. Liver biopsy in thyrotoxicosis. Acta Med Scand 1947; 127:439–445.
Movitt ER, Gerstl B, Davis AE. Needle liver biopsy in thyrotoxicosis. Arch Intern Med 1953; 91:729–739.
Klion FM, Segal R, Schaffner F. The effect of altered thyroid function on the ultrastructure of the human liver. Am J Med 1971; 50:317–324.
Sellin JH, Vasilopoulou-Sellin R. The gastrointestinal tract and liver in thyrotoxicosis. In: Brauerman LE, Utiger RD, editors. Werner & Ingbar’s the thyroid: a fundamental and clinical text. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2000. pp. 622–626.
Sheridan P. Thyroid hormones and the liver. Clin Gastroenterol 1983; 12:797–818.
Kim DDRJ, editors. Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology, diagnosis, management. New York: Saunders; 2002.
Tibi L, Patrick AW, Leslie P, Toft AD, Smith AF. Alkaline phosphatase isoenzymes in plasma in hyperthyroidism. Clin Chem 1989; 35: 1427–1430.
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Evlice, M., Aksoz, Z. Thyrotoxicosis associated with severe hypoalbuminemia and hyperbilirubinemia. Egypt J Intern Med 29, 196–198 (2017). https://doi.org/10.4103/ejim.ejim_7_17
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DOI: https://doi.org/10.4103/ejim.ejim_7_17