A case of thyroid storm complicated by acute hepatitis due to propylthiouracil treatment

Summary A 57-year-old female presented 17 days after treatment with radioactive iodine (RAI) for difficult-to-control hyperthyroidism. She was febrile, had a sinus tachycardia, and was clinically thyrotoxic. Her thyroid function tests showed a suppressed TSH 75 pmol/l and total triiodothyronine (TT3...

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Bibliographic Details
Published in:Endocrinology, diabetes & metabolism case reports diabetes & metabolism case reports, 2015-08, Vol.2015, p.150052-150052
Main Authors: Tufton, Nicola, Hashim, Nazhri, Sze, Candy, Waterhouse, Mona
Format: Article
Language:English
Subjects:
Adult
Female
Glucocorticoids
Iatrogenic disorder
Liver failure
Liver function
Paracetamol
Prednisolone
Propranolol
Propylthiouracil
Pyrexia
Radionuclide therapy
Tachycardia
Thyroid
Thyroid nodule
Thyroid scintigraphy
Thyroid storm
Thyroxine (T4)
Total T3
Triiodothyronine (T3)
TSH
Ultrasound scan
United Kingdom
Unusual Effects of Medical Treatment
White
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Summary:Summary A 57-year-old female presented 17 days after treatment with radioactive iodine (RAI) for difficult-to-control hyperthyroidism. She was febrile, had a sinus tachycardia, and was clinically thyrotoxic. Her thyroid function tests showed a suppressed TSH 75 pmol/l and total triiodothyronine (TT3) 6.0 nmol/l. She was diagnosed with thyroid storm and was managed with i.v. fluids, propylthiouracil (PTU) 200 mg four times a day, prednisolone 30 mg once daily and propanolol 10 mg three times a day. She gradually improved over 2 weeks and was discharged home on PTU with β blockade. On clinic review 10 days later, it was noted that, although she was starting to feel better, she had grossly abnormal liver function (alanine transaminase (ALT) 852 U/l, bilirubin 46 μmol/l, alkaline phosphatase (ALP) 303 U/l, international normalized ratio (INR) 0.9, platelets 195×109/l). She was still mildly thyrotoxic (TSH
ISSN:2052-0573
2052-0573
DOI:10.1530/EDM-15-0052