Endocrine Abstracts

Introduction: Hepatic encephalopathy is a neuropsychological syndrome complicating a chronic liver disease (cirrhosis), rarely acute (fulminant hepatitis). We report the case of a patient with Graves’ disease who suddenly presented with hepatic encephalopathy.

Case Report: S.B., a 48-year-old woman followed for Graves’ disease treated with antithyroid drugs and also presenting vitiligo, was admitted to our facility for a relapse of Graves’ disease with major hyperthyroidism (TSH < 0.05 and T4l: 100 pmol) and cholestatic jaundice. The patient benefited from a plasmapheresis session and the evolution was characterized by a picture of hepatic encephalopathy made of behavioral disorders and biochemically, low prothrombin, low albumin, and major cholestasis.

Discussion: The pathophysiology of hepatic dysfunction in hyperthyroidism is multifactorial; it can be secondary to hyperthyroidism or associated with autoimmune liver disease, especially primary biliary cirrhosis and autoimmune hepatitis. In our patient, given the autoimmune context, especially vitiligo, and Graves’ disease, it is very likely a non-known liver pathology, either primary biliary cirrhosis or autoimmune hepatitis, complicated by hepatic encephalopathy.

Conclusion: Graves’ disease can be associated with several autoimmune disorders, including liver involvement. Screening for these disorders is important as they can affect the patient’s prognosis.