Clinical Case Report: Dissociation of Clinical Course of Coexisting Autoimmune Hepatitis and Graves Disease.
Clinical Case Report: Dissociation of Clinical Course of Coexisting Autoimmune Hepatitis and Graves Disease.
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DOI：
10.1016/j.aace.2020.11.007
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发表时间：
2021-01
影响因子：
--
通讯作者：
Vellanki P
中科院分区：
文献类型：
--
作者：
Patel AM;Stanback C;Vellanki P
据报道，格雷夫斯病会并发自身免疫性疾病，包括自身免疫性肝炎 (AIH)。糖皮质激素可以同时降低甲状腺激素水平并治疗 AIH。甲亢复发与肝炎复发相关。我们提出了一个同时存在 AIH 和格雷夫斯甲状腺毒症的病例，该病例在泼尼松治疗后有所改善，但在泼尼松逐渐减量期间，甲状腺毒症复发，而肝炎仍处于缓解状态。评估包括肝酶水平的测量、甲状腺功能测试和甲状腺刺激抗体以及腹部超声、磁共振成像和肝活检。一名 47 岁女性因恶心和黄疸就诊。检查显示天冬氨酸转氨酶水平为 1956（参考值，10-42）U/L，丙氨酸转氨酶水平为 1634（参考值，14-54）IU/L。肝活检符合 AIH。九个月后，她出现心悸、耐热和体重减轻的症状，并被诊断患有格雷夫斯病。患者每天接受泼尼松 60 mg，1 个月后肝脏和甲状腺功能恢复正常。泼尼松剂量逐渐减少至每天 5 毫克。七个月后，她的促甲状腺激素水平为 0.049（参考值，0.340-5.6）μIU/mL），游离甲状腺素水平为 3.96（参考值，0.58-1.64）ng/dL。肝酶保持在正常水平。治疗甲状腺功能亢进时，泼尼松剂量从 5 毫克增加到 20 毫克。患者被转诊接受甲状腺切除术，诊断为格雷夫斯病合并甲状腺毒症。该病例是格雷夫斯病和AIH共存的一个例子，具有不同的临床过程。尽管糖皮质激素治疗初步解决了问题，但格雷夫斯病复发，而 AIH 仍处于缓解状态。
Concurrent autoimmune disorders, including autoimmune hepatitis (AIH), with Graves disease have been reported. Glucocorticoids can simultaneously lower thyroid hormone levels and treat AIH. Recurrence of hyperthyroidism is associated with recurrence of hepatitis. We present a case of coexisting AIH and Graves thyrotoxicosis, which improved with prednisone, but the thyrotoxicosis recurred during a prednisone taper while the hepatitis stayed in remission. Evaluation included measurements of liver enzyme levels, thyroid function tests, and thyroid-stimulating antibodies as well as abdominal ultrasound, magnetic resonance imaging, and liver biopsy. A 47-year-old woman presented with nausea and jaundice. Workup showed an aspartate aminotransferase level of 1956 (reference, 10-42) U/L and alanine aminotransferase level of 1634 (reference, 14-54) IU/L. The liver biopsy was consistent with AIH. Nine months later, she reported palpitations, heat intolerance, and weight loss and was diagnosed with Graves disease. The patient received prednisone at 60 mg daily, and the liver and thyroid functions normalized after 1 month. Prednisone was tapered to 5 mg daily. Seven months later, she presented with a thyroid-stimulating hormone level of 0.049 (reference, 0.340-5.6) μIU/mL) and free thyroxine level of 3.96 (reference, 0.58-1.64) ng/dL. Liver enzymes remained at normal levels. Prednisone was increased from 5 to 20 mg to treat hyperthyroidism. The patient was referred for thyroidectomy for a diagnosis of Graves disease with thyrotoxicosis. This case is an example of coexisting autoimmune diseases, Graves disease and AIH, with different clinical courses. Despite initial resolution with glucocorticoid therapy, Graves disease recurred, while AIH stayed in remission.