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Hepato-renal manifestation of untreated severe hypothyroidism


Authors: X. Faktorová 1;  Zelinková Z. 1;  Horniaková L. 2;  Havranová A. 3;  Trejbalová Ľ. 4;  Z. Ďurkovičová 2;  M. Szántová 2
Authors‘ workplace: Interná klinika SZU a UN – Nemocnica svätého Michala, a. s., Bratislava 1;  III. interná klinika LF UK a UN Bratislava 2;  I. rádiologická klinika LF UK, SZU a UN Bratislava 3;  I. interná klinika SZU v Bratislave 4
Published in: Gastroent Hepatol 2022; 76(2): 127-130
Category: Case Report
doi: https://doi.org/10.48095/ccgh2022127

Overview

Primary hypothyroidism based on autoimmune thyroiditis is one of the most common thyroid diseases in countries which sufficient iodine intake. It is 5-times more common in women. We report a rare case of hepatopathy in unrecognized severe hypothyroidism. A 46-years- -old man was sent to the hospital by his general practitioner for increased hepatic enzymes during a preventive check-up, with a 2-month history of pain in the right hypochondrium. Laboratory examination showed a 4-fold increase in transaminases and a 7-fold increase in cholestatic enzymes, with positivity for ANA, p-ANCA and aTPO autoantibodies, mild hemolytic anemia, a slight increase in creatinine. Imaging methods (USG, CT, MRCP) showed hepatosplenomegaly and bilateral fluidothorax. The dia­gnosis was established after excluding infectious, metabolic, toxic and oncological etiology and by confirming extremely high level of TSH with reduced fT4 and fT3. Due to autoimmune presentation and suspected ANCA vasculitis, a kidney bio­psy was performed, showing no pathology. Treatment with levothyroxine and hepatoprotective agents led to a rapid resolution of difficulties and normalization of laboratory parameters within 5 months of starting treatment. This case report highlights the need for considering the rare etiology of hepatopathy in chronic untreated hypothyroidism.

Keywords:

Hypothyroidism – autoimmune thyroiditis – hepatopathy


Sources

1. Kiňová S, Koreň M. Tyreopatie v ambulancii všeobecného lekára. Via Pract 2016; 13 (6): 252–255.

2. Malespin M, Nassri A. Endocrine diseases and the liver: an update. Clin Liver Dis 2019; 23 (2): 233–246. doi: 10.1016/j.cld.2018.12.006.

3. Huang MJ, Liaw YF. Clinical associations between thyroid and liver diseases. J Gastroenterol Hepatol 1995; 10 (3): 344–350. doi: 10.1111/j.1440-1746.1995.tb01106.x.

4. Brunová J. Dia­gnostika a terapie poruch funkce štítne žlázy – část I. Med Pro Praxi 2008; 5 (6): 254–257.

5. Burra P. Liver abnormalities and endocrine diseases. Best Pract Res Clin Gastroenterol 2013; 27 (4): 553–563. doi: 10.1016/j.bpg.2013.06. 014.

6. Krüskemper HL, Gillich KH, Zeidler U et al. Serum enzyme activities in thyroid function disorders. Dtsch Med Wochenschr 1968; 93 (22): 1099–1103. doi: 10.1055/s-0028-1105199.

7. Moller-Petersen J, Andersen PT, Lervang HH. Hypothyroidism and serum enzyme. Ugeskr Laeger. 1988; 150 (34): 2019–2022.

8. Saha B, Maity C. Alteration of serum enzymes in primary hypothyroidism. Clin Chem Lab Med 2002; 40 (6): 609–611. doi: 10.1515/CCLM.2002.105.

9. Piantanida P, Ippolito S, Gallo D et al. The interplay between thyroid and liver: implications for clinical practise. J Endocrinol Invest 2020; 43 (7): 885–899. doi: 10.1007/s40618-020-01208-6.

10. Maser C, Toset A, Roman S. Gastrointestinal manifestations of endocrine disease. World J Gastroenterol 2006; 12 (20): 3174–3179. doi: 10.3748/wjg.v12.i20.3174.

11. Carvalho GA, Fighera TM. Effect of gastrointestinal disorders in autoimmune thyroid diseases. Transl Gastrointest Cancer 2015; 4 (1): 76–82. doi: 10.3978/j.issn.2224-4778.2014.07.03.

12. Bassotti G, Pagliacci MC, Nicoletti I et al. Intestinal pseudoobstruction secondary to hypothyroidism. Importance of small bowel manometry. J Clin Gastroenterol 1992; 14 (1): 56–58. doi: 10.1097/00004836-199201000-00 014.

13. Podoba J. Tyreopatie v ambulancii praktického lekára, alebo ako zvládnuť ich súčasnú „epidémiu“? Via Pract 2009; 6 (4): 142–146.

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Paediatric gastroenterology Gastroenterology and hepatology Surgery

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Gastroenterology and Hepatology

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2022 Issue 2

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