Cholestasis and protein-losing enteropathy secondary to hyperthyroidism in a 6-year-old girl
-
Lamia Gargouri
,
Manel Charfi
Abstract
Hepatic dysfunctions are not infrequent in patients with hyperthyroidism. These disorders may be related to the effects of the excess thyroid hormone secretion, to the uses of antithyroid drugs, or to the presence of concomitant hepatic diseases. Our aim is to describe the clinical and biochemical features of liver dysfunction related to thyrotoxicosis. We report here a case of a 6-year-old girl who was admitted for jaundice and pruritus as a result of the development of hyperthyroidism due to Graves’ disease. On physical examination at admission, she was found to have jaundice and hepatomegaly. Laboratory data show cholestasis and protein-losing enteropathy. Investigations exclude other causes of hepatic disorder. One month after the initiation of antithyroid drug, the patient became euthyroid with improvement in jaundice and pruritus and normalization of hepatic tests and alpha antitrypsine clearance. In conclusion, the diagnosis of hyperthyroidism may be delayed in patients in whom the primary manifestations were pruritus and jaundice. The physician should suspect thyrotoxicosis prior to hepatitis or skin manifestations.
References
1. Youssef WI, Mullen KD. The liver in other (non diabetic) endocrine disorders. Clin Liver Dis 2002;6:879–89.10.1016/S1089-3261(02)00049-1Suche in Google Scholar
2. Kubota S, Amino N, Matsumoto Y, Ikeda N, Morita S, et al. Serial changes in liver function tests in patients with thyrotoxicosis induced by Graves’ disease and painless thyroiditis. Thyroid 2008;18:283–7.10.1089/thy.2007.0189Suche in Google Scholar
3. Hull K, Horenstein R, Naglieri R, Munir K, Ghany M, et al. Two cases of thyroid storm-associated cholestatic jaundice. Endocr Pract 2007;13:476–80.10.4158/EP.13.5.476Suche in Google Scholar
4. Choudhary AM, Roberts I. Thyroid storm presenting with liver failure. J Clin Gastroenterol 1999;29:318–21.10.1097/00004836-199912000-00004Suche in Google Scholar
5. Tzemanakis E, Papanikolaou IS, Zervas A, Malachtari S, Dourakis SP. Acute icteric hepatitis as the main manifestation of hyperthyroidism. Ann Gastroenterol 2000;13:54–7.Suche in Google Scholar
6. De Campos Mazo DF, de Vasconcelos GB, Pereira MA, de Mello ES, Bacchella T, et al. Clinical spectrum and therapeutic approach to hepatocellular injury in patients with hyperthyroidism. Clin Exp Gastroenterol 2013;6:9–17.10.2147/CEG.S39358Suche in Google Scholar
7. Habershon SO. Exophthalmic goiter, heart disease, jaundice, death. Lancet 1874;i:510.10.1016/S0140-6736(02)45227-0Suche in Google Scholar
8. Soylu A, Taskale MG, Ciltas A, Kalayci M, Kumbasar AB. Intrahepatic cholestasis in subclinical and overt hyperthyroidism: two case reports. J Med Case Rep 2008;2:116.10.1186/1752-1947-2-116Suche in Google Scholar
9. Sjöberg GK, Katzman P, Hallengren B. Liver cholestasis in thyrotoxicosis: a case report. Int J Endocrinol Metab 2007;1: 44–8.Suche in Google Scholar
10. Bellassoued M, Mnif M, Kaffel N, Rekik N, Rebai T, et al. Thyrotoxicosis hepatitis: a case report. Ann Endocrinol (Paris) 2001;62:235–8.Suche in Google Scholar
11. Ramanathan M, Abidin MN, Muthukumarappan M. The prevalence of skin manifestations in thyro-toxicosis – a retrospective study. Med J Malaysia 1989;44:324–8.Suche in Google Scholar
12. Chen W-C, Zhu Z-X, Wang C-H, Chien M-N. Cholestasis and acute cholecystitis in hyperthyroidism treated with methimazole. Int J Gerontol 2009;3:248–50.10.1016/S1873-9598(10)70009-0Suche in Google Scholar
©2014 by De Gruyter
Artikel in diesem Heft
- Frontmatter
- Review article
- Towards an optimization of the management of endocrine complications of thalassemia
- Original articles
- The natural course of Hashimoto’s thyroiditis in children and adolescents
- Muscle strength and body composition during the transition phase in patients treated with recombinant GH to final height
- Benign vaginal bleeding in 24 prepubertal patients: clinical, biochemical and imaging features
- Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents
- Counseling patients with succinate dehydrogenase subunit defects: genetics, preventive guidelines, and dealing with uncertainty
- Pubertal development profile in patients with Turner syndrome
- A novel CASR mutation associated with neonatal severe hyperparathyroidism transmitted as an autosomal recessive disorder
- Serum insulin-like growth factor-binding protein-3 level correlated with glycemic control and lipid profiles in children and adolescents with type 1 diabetes
- Adult human liver mesenchymal progenitor cells express phenylalanine hydroxylase
- Clinical applicability of rapid detection of SRY and DYS14 genes in patients with disorders of sex development using an indigenously developed 5′ exonuclease based assay
- Hereditary 1,25-dihydroxyvitamin D-resistant rickets with alopecia in four Egyptian families: report of three novel mutations in the vitamin D receptor gene
- Permanent neonatal diabetes mellitus in Jordan
- The effect of adenotonsilectomy on ghrelin, leptin, IGF-1 levels and growth parameters in children with adenotonsillar hypertrophy
- The role of anti-Mullerian and inhibin B hormones in the evaluation of 46,XY disorders of sex development
- The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders
- Lipid patterns in treated growth hormone deficient children vs. short stature controls
- Assessment of aortic morphology and compliance in children and adolescents with Ullrich-Turner syndrome (UTS) using magnetic resonance imaging (MRI)
- Management of central diabetes insipidus with oral desmopressin lyophilisate in infants
- Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone
- Patient reports
- A rare case of pituitary infarction leading to spontaneous tumour resolution and CSF-sella syndrome in an 11-year-old girl and a review of the paediatric literature
- Rare case of homozygous epimerase deficiency and heterozygous of duarte 2 variant
- Persistent congenital hyperinsulinism in two patients with Beckwith-Wiedemann syndrome due to mosaic uniparental disomy 11p
- Growth hormone treatment in a patient with Hurler-Scheie syndrome
- Neonatal diagnosis of a patient with hypoparathyroidism, sensorineural deafness and renal dysplasia (HDR) syndrome associated with cerebral infarction
- Early-onset diabetes mellitus and neurodevelopmental retardation: the first Greek case of Wolcott-Rallison syndrome
- Type III Bartter-like syndrome in an infant boy with Gitelman syndrome and autosomal dominant familial neurohypophyseal diabetes insipidus
- Cushing’s syndrome: hidden risk in usage of topical corticosteroids
- Prader-Willi syndrome: a case report with atypical developmental features
- Berardinelli-Seip congenital lipodystrophy: an autosomal recessive disorder with rare association of duodenocolonic polyps
- Ectopic Cushing syndrome secondary to metastatic medullary thyroid cancer in a child with multiple endocrine neoplasia syndrome type 2B: clues to early diagnosis of the paraneoplastic syndromes
- Ovarian hyperstimulation syndrome treated by medroxyprogesterone acetate
- Symptomatic cerebral infarction in a child with severe diabetic ketoacidosis
- A rare case of familial Cushing’s syndrome with a common presentation of weight gain due to a mutation of the PRKAR1A gene causing isolated primary pigmented nodular adrenocortical disease
- Multiple autoimmunity, type 1 diabetes (T1DM), autoimmune thyroiditis and thyroid cancer: is there an association? A case report and literature review
- Cholestasis and protein-losing enteropathy secondary to hyperthyroidism in a 6-year-old girl
- Short communication
- An essential splice site mutation (c.317+1G>A) in the TSHR gene leads to severe thyroid dysgenesis
- Letter to the Editor
- Pubertal gynecomastia: what about the remaining 10%?
Artikel in diesem Heft
- Frontmatter
- Review article
- Towards an optimization of the management of endocrine complications of thalassemia
- Original articles
- The natural course of Hashimoto’s thyroiditis in children and adolescents
- Muscle strength and body composition during the transition phase in patients treated with recombinant GH to final height
- Benign vaginal bleeding in 24 prepubertal patients: clinical, biochemical and imaging features
- Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents
- Counseling patients with succinate dehydrogenase subunit defects: genetics, preventive guidelines, and dealing with uncertainty
- Pubertal development profile in patients with Turner syndrome
- A novel CASR mutation associated with neonatal severe hyperparathyroidism transmitted as an autosomal recessive disorder
- Serum insulin-like growth factor-binding protein-3 level correlated with glycemic control and lipid profiles in children and adolescents with type 1 diabetes
- Adult human liver mesenchymal progenitor cells express phenylalanine hydroxylase
- Clinical applicability of rapid detection of SRY and DYS14 genes in patients with disorders of sex development using an indigenously developed 5′ exonuclease based assay
- Hereditary 1,25-dihydroxyvitamin D-resistant rickets with alopecia in four Egyptian families: report of three novel mutations in the vitamin D receptor gene
- Permanent neonatal diabetes mellitus in Jordan
- The effect of adenotonsilectomy on ghrelin, leptin, IGF-1 levels and growth parameters in children with adenotonsillar hypertrophy
- The role of anti-Mullerian and inhibin B hormones in the evaluation of 46,XY disorders of sex development
- The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders
- Lipid patterns in treated growth hormone deficient children vs. short stature controls
- Assessment of aortic morphology and compliance in children and adolescents with Ullrich-Turner syndrome (UTS) using magnetic resonance imaging (MRI)
- Management of central diabetes insipidus with oral desmopressin lyophilisate in infants
- Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone
- Patient reports
- A rare case of pituitary infarction leading to spontaneous tumour resolution and CSF-sella syndrome in an 11-year-old girl and a review of the paediatric literature
- Rare case of homozygous epimerase deficiency and heterozygous of duarte 2 variant
- Persistent congenital hyperinsulinism in two patients with Beckwith-Wiedemann syndrome due to mosaic uniparental disomy 11p
- Growth hormone treatment in a patient with Hurler-Scheie syndrome
- Neonatal diagnosis of a patient with hypoparathyroidism, sensorineural deafness and renal dysplasia (HDR) syndrome associated with cerebral infarction
- Early-onset diabetes mellitus and neurodevelopmental retardation: the first Greek case of Wolcott-Rallison syndrome
- Type III Bartter-like syndrome in an infant boy with Gitelman syndrome and autosomal dominant familial neurohypophyseal diabetes insipidus
- Cushing’s syndrome: hidden risk in usage of topical corticosteroids
- Prader-Willi syndrome: a case report with atypical developmental features
- Berardinelli-Seip congenital lipodystrophy: an autosomal recessive disorder with rare association of duodenocolonic polyps
- Ectopic Cushing syndrome secondary to metastatic medullary thyroid cancer in a child with multiple endocrine neoplasia syndrome type 2B: clues to early diagnosis of the paraneoplastic syndromes
- Ovarian hyperstimulation syndrome treated by medroxyprogesterone acetate
- Symptomatic cerebral infarction in a child with severe diabetic ketoacidosis
- A rare case of familial Cushing’s syndrome with a common presentation of weight gain due to a mutation of the PRKAR1A gene causing isolated primary pigmented nodular adrenocortical disease
- Multiple autoimmunity, type 1 diabetes (T1DM), autoimmune thyroiditis and thyroid cancer: is there an association? A case report and literature review
- Cholestasis and protein-losing enteropathy secondary to hyperthyroidism in a 6-year-old girl
- Short communication
- An essential splice site mutation (c.317+1G>A) in the TSHR gene leads to severe thyroid dysgenesis
- Letter to the Editor
- Pubertal gynecomastia: what about the remaining 10%?
