Abstract
ObjectiveTo describe the association of the rare and serious complication of liver toxicity in previously healthy Grave’s disease (GD) patients after the treatment with radioactive iodine 131I (RAI).Case presentationWe report the clinical, laboratory and pathologic findings of 2 cases of severe liver toxicity associated with the treatment with RAI in previously healthy patients with GD. Clinical examination and laboratory investigations excluded viral hepatitis, autoimmune hepatitis, granulomatous disease, primary biliary disease, extrahepatic biliary obstruction, and heart failure.Case 1: A previously healthy 52-years old man reportedly having a typical GD but following RAI treatment, concomitantly developed severe liver toxicity that required 1 week of treatment in hospital.Case 2: A previously healthy 34-years old woman is reported as having a typical GD but developed jaundice following RAI treatment that required several weeks of in hospital treatment in the hepato-biliary department.In both cases, the liver dysfunction resolved after intensive treatment with hepato-protective agents. In this report the therapeutic considerations as well as the pathogenetic possibilities are reviewed.ConclusionTo the best of our knowledge, this is the first description of the association observed, which is rare but may be severe and should be considered in any case of thyrotoxicosis where a liver dysfunction develops after the treatment with radioactive iodine 131I.
Highlights
Graves’ disease is the most common cause of hyperthyroidism in iodine-sufficient areas [1]
To the best of our knowledge, this is the first description of the association observed, which is rare but may be severe and should be considered in any case of thyrotoxicosis where a liver dysfunction develops after the treatment with radioactive iodine Radioactive iodine (131I)
Several therapeutic options are available for the treatment of hyperthyroidism due to Grave’s disease (GD), including antithyroid drug medication (ATD), near-total resection (NTR) and radioiodine therapy (RIT)
Summary
Hepatic toxicity is a rather uncommon event after RAI treatment, physicians should be aware of this probable complication and consider starting an early hepato-protective treatment regimen prior to administration of RAI. While there are controversies in treatment of thyrotoxicosis with RAI, with appropriate patient selection and regular follow-up, radioiodine is a safe and effective modality in achieving high cure rates [18]. Consent Written informed consent was obtained from the patients for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions NPJ wrote the first draft. NPJ and BT were in a position of leadership for the patients and collected information on the patients. BT and NPJ did the literature searches. BT wrote the final manuscript and made appropriate revisions. QS supervised the writing of the manuscript. All authors read through and approved the final manuscript
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