Endocrine Abstracts

Introduction: Liver function abnormalities in hyperthyroidism are common, several abnormalities have been reported: hepatic cytolysis, cholestasis, insufficiency or even non-specific abnormalities. The pathophysiology of hepatic dysfunction secondary to hyperthyroidism is not yet well established. Graves’ disease can be associated with various autoimmune diseases. However, association with Primary biliary cirrhosis has been described in few cases in literature. We report a case of Graves’ disease revealing primary biliary cirrhosis

Case report: F, I, 47-year-old female patient, with no pathological history, consults for a syndrome of thyrotoxicosis. Physical examination showed: Bulging eyes, homogeneous diffuse goiter, with vascular thrill. Thyroid function tests revealed : low serum TSH <0.05 U/l, and high serum free T4:51.46 pmol/l and free T3: 19.6 pmol/l. An ultrasound exam showed an enlarged thyroid with increased vascularity, compatible with thyroiditis. Meanwhile, the patient presented a cholestasis and cytolysis syndrom, serology tests for hepatitis were negative; high level of total IGGs, anti-mitochondrial antibodies not made. The abdominal ultrasound: dysmorphic liver. On fibroscann : Elasticity estimated at 11.4 (F3) The patient was put on prednisone and beta blocker, with a normalization of liver and thyroid tests. Then a total thyroidectomy was performed. The anatomopathological study confirmed the diagnosis of Graves’ disease.

Discussion: Hepatic involvement in Graves’ disease is uncommon, however, abnormal liver function tests are relatively common. Clinical and biological cholestasis syndromes are less common. The pathophysiology of hepatic dysfunction in hyperthyroidism is multifactorial, it may be secondary to hyperthyroidism, to antithyroid drugs, or associated with autoimmune liver disease. Various theories attempt to explain cholestasis in hyperthyroidism. Its association with hyper metabolism, increases hepatic oxygen consumption, without an increase in hepatic blood flow, and therefore a decrease in oxygen in the centrilobular areas. Our patient had a clinical and biological cholestasis syndrome, the etiological assessment was negative, the fibroscann confirmed hepatic cirrhosis. The normalization of liver tests under corticosteroids is in favor of diagnosis of primary biliary cirrhosis.

Conclusion: Primary biliary cirrhosis is another autoimmune disease that should be considered as an association with Grave’s disease when other causes of cholestasis syndrome are ruled out. Early identification could help plan disease management and prognosis improvement.

Bibliography: Grave’s Disease and Primary Biliary Cirrhosis—An Unusual and Challenging Association Shiran Shetty*, Senthilkumar Rajasekarany, Leela Venkatakrishnan* Journal of Clinical and Experimental Hepatology, 2014, 4(1): 66–67