Hepatitis Acute Fulminant and Thyrotosicosis

• Autor(a) principal: Miranda, Carla Paixão
• Data de Publicação: 2017
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista Científica da Faculdade de Medicina de Campos
• Texto Completo: https://www.fmc.br/ojs/index.php/RCFMC/article/view/37
• topic: Tireoide; Hepatite; Fígado; Inflamação; Tireotoxicose; Inflammation; Thyroid; Liver; Thyrotoxicosis; Hepatitis

Herein, we present the case of a female patient, 44 years old, who was transferred to the intensive care center (ICU) of the Hospital das Clínicas in Belo Horizonte/MG, with abdominal pain, nausea, vomiting, jaundice and fever, anorexia, loss of appetite, whose symptoms began 30 days ago. She has a history of hypothyroidism being treated irregularly with T4 for the last five years and stopped the treatment when the current symptoms appeared. She presented T3 (7.26 pg/mL) VN: 2.77 to 5.07; TSH (0.214 IU/mL) VN: 0.465. Transaminases AST (977 U/L) VN: 15 to 46; ALT (795 U/L) VN:13 to 69; bilirubin total (4.12 mg/dL) VN: 0.2 to 1.3; direct bilirubin (30 mg/dL) VN: up to 0.25. She was maintained without anti-thyroid and was started on propranolol at a dosage of up to 480 mg/day. An MRI abdominal exam presented cholangiocarcinoma with free abdominal fluid, suggestive of being related to the inflammatory process. There was non-specific thickening of the gallbladder and bilateral pleural effusion. The serology exam for Hepatitis A, B, and C was negative. There was liver function deterioration and high levels of thyroid hormones were maintained. The patient suffered an acute fulminant hepatic failure and was immediately submitted to a hepatic transplant.  After the procedure the liver (explant) was sent for anatomopathological study; histopathologic findings included the presence of an extensive area of necrosis of the liver parenchyma. The remaining septa showed mononuclear inflammatory infiltrates (MNII). Therefore, it was concluded that chronic hyperthyroidism can exacerbate and perpetuate acute fulminant hepatic failur and that regular medicinal treatment, together with clinically routine laboratory exames could prevent serious complications, permitting successful therapy in patients with hyperthyroidism.