Abstract
Jaundice and hepatic dysfunction have been reported in patients with thyrotoxicosis and could be due to different mechanisms. To describe three cases of jaundice occurring in patients with thyrotoxicosis and to illustrate the importance of early institution of thionamides when indicated. We present the clinical and laboratory features of three patients presenting within a year with thyrotoxicosis and jaundice and whose clinical conditions improved remarkably following treatment with thionamides. In addition, current literature on the subject is reviewed and summarised. The three patients presented with goitre and jaundice. None of the patients had received blood products, undergone scarification markings or experienced any previous episode of jaundice. Thyroid function tests in the three patients were consistent with a diagnosis of thyrotoxicosis. Liver function tests showed elevated bilirubin and transaminases. All patients improved remarkably following treatment with thionamides. It is important to rule out thyrotoxicosis in patients with jaundice of unknown cause and consider early use of thionamides for treatment of the thyrotoxicosis, if confirmed.
Highlights
Thyrotoxicosis presenting with jaundice and abnormalities in liver function tests, though not common, has been reported in literature[1,2,3]
Jaundice in patients with thyrotoxicosis could be due to the thyrotoxicosis itself, could be as a result of drug treatment of the thyrotoxicosis, could be due to conditions associated with autoimmune thyroid disease like autoimmune hepatitis or could be due to unrelated conditions like sepsis or viral hepatitis
We report three patients who presented to our hospital within the same year with thyrotoxicosis, jaundice and hepatic dysfunction
Summary
Thyrotoxicosis presenting with jaundice and abnormalities in liver function tests, though not common, has been reported in literature[1,2,3]. Propanolol and carbimazole were commenced and she made significant improvement with resolution of the jaundice She was discharged after two months to be followed up in the endocrine clinic. Physical examination revealed a toxic-looking young woman, wasted, pale, deeply icteric, febrile, and dehydrated She had a staring gaze and bilateral proptosis, lid lag and lid retraction. She had a goitre with right and left lobes measuring 6 by 4cm and 5 by 2 cm respectively, smooth, soft, and non-tender. Tests of hepatic function showed total bilirubin 4.0 (normal 0.2-1.0)mg/dl, alanine aminotransferase 134(0-40) I.U/L, aspartate aminotransferase 202 (0-37) I.U/L, alkaline phosphatase 103 (30-150) I.U/L, total protein 7.7mg/dl (6.0-8.0)g/dl, albumin 2.1mg/dl (3.55.0)g/dl. Hepatic function tests could not be repeated due to financial constraints She was commenced on aldactone, intranasal oxygen therapy, propanolol, carbimazole and anti-liver failure regimen. She is currently doing well and thyroid function has improved remarkably
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