基底格雷夫斯病的急性药物性胆汁淤积综合征

Robert Aurelian Tiucă, A. Boeriu, R. Georgescu, I. Pașcanu
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引用次数: 1

摘要

摘要简介:Graves病(GD)是一种由高水平的抗促甲状腺激素受体自身抗体引起的自身免疫性疾病,被认为是甲状腺毒症的最常见原因,以甲状腺肿、眼病和皮肤病为特征。在我国,抗甲状腺药物(ATD)是治疗该病的第一线药物。副作用很少,但其中一些,如粒细胞缺乏症或肝损伤,可能会变得严重。病例介绍:我们报告了一例20岁的女性患者,她在先前诊断为病毒性甲型肝炎后被诊断为GD,开始使用甲巯咪唑30 mg/天治疗,三周后出现强烈的肝细胞溶解和胆汁淤积综合征,因此停止了ATD。怀疑自身免疫性肝病提出,并进行肝活检,以建立诊断。甲状腺功能亢进的下一个治疗选择是放射性碘(RAI)。RAI后3个月,患者出现严重甲状腺功能减退,开始左旋甲状腺素治疗。结论:重度急性肝损伤虽少见,但轻度肝功能障碍在GD患者中较为常见。甲状腺激素分泌过多,或通过免疫介导的过程或药物反应治疗ATD,可能是导致肝损伤的机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute Drug-Induced Cholestatic Syndrome in Basedow Graves’ Disease
Abstract Introduction: Graves’ disease (GD), an autoimmune disorder caused by high levels of auto-antibodies against the thyroid-stimulating hormone receptor, is considered the most common cause of thyrotoxicosis, characterized by features such as goiter, ophthalmopathy and dermopathy. In our country, the administration of antithyroid drugs (ATD) is the first line of treatment in this disease. Side effects are rare but some of them, such as agranulocytosis or liver damage, may become serious. Case presentation: We report the case of a 20-year-old female patient who was diagnosed with GD after being previously diagnosed with viral hepatitis A. Treatment was initiated with methimazole 30 mg/day, and three weeks later she developed intense hepatic cytolysis and cholestatic syndrome, therefore the ATD was stopped. A suspicion of autoimmune liver disease was raised, and a liver biopsy was performed in order to establish the diagnosis. The next therapeutic option for hyperthyroidism was radioactive iodine (RAI). Three months following RAI, the patient presented severe hypothyroidism, thereupon treatment with levothyroxine was initiated. Conclusions: Although severe acute liver injury is rare, mild liver dysfunction is quite common in patients with GD. The overproduction of thyroid hormones, or the treatment with ATD through immune mediated processes or drug reactions, represent possible mechanisms responsible for liver damage.
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