Korean J Gastroenterol.  2015 Jan;65(1):48-51. 10.4166/kjg.2015.65.1.48.

A Case of Autoimmune Hepatitis Combined with Graves' Disease

• Jhee JH
• Kim HJ
• Kang W
• Kim S
• Kim DY

• KMID: 2373180
• DOI: http://doi.org/10.4166/kjg.2015.65.1.48

Abstract

A 25-year-old woman presented with jaundice, palpitation, and weight loss of 5 kg during a period of 2 weeks. Laboratory tests showed elevated levels of liver enzymes (AST 1,282 IU/L, ALT 1,119 IU/L) and total bilirubin (6.4 mg/dL); negative for hepatitis virus infection; elevated serum levels of triiodothyronine (T3, 3.60 ng/dL), free thyroxine (fT4, 3.82 ng/dL), and lowered serum level of thyroid stimulating hormone (TSH, <0.025 microIU/mL); and positive for thyroid stimulating antibody and anti-mitochondrial antibody (AMA). The liver biopsy findings were consistent with autoimmune hepatitis (AIH). Accordingly, oral steroid therapy was started with 60 mg of prednisolone under the impression of AIH associated with Graves' disease. After a week of steroid therapy, the clinical manifestation showed significant improvement, with normalization of both liver and thyroid functions. Diagnosis of the liver condition of patients who present with hyperthyroidism and liver dysfunction is important, so that appropriate therapy can be promptly initiated.

Keyword

Autoimmune hepatitis; Graves disease; Steroid

MeSH Terms

Adult
Alanine Transaminase/analysis
Antibodies, Antinuclear/blood
Aspartate Aminotransferases/analysis
Bilirubin/blood
Female
Graves Disease/complications/*diagnosis/drug therapy
Hepatitis, Autoimmune/complications/*diagnosis/drug therapy
Humans
Immunoglobulins, Thyroid-Stimulating/blood
Liver/enzymology/metabolism/pathology
Prednisolone/therapeutic use
Steroids/therapeutic use
Thyrotropin/blood
Alanine Transaminase
Antibodies, Antinuclear
Aspartate Aminotransferases
Bilirubin
Immunoglobulins, Thyroid-Stimulating
Prednisolone
Steroids
Thyrotropin

Figure

• 

  Fig. 1. Histologic findings of liver biopsies are consistent with autoimmune hepatitis (H&E, ×200). (A) Severe necroinflammatory activity with marked portal lymphoplasma cell infiltration with occasional eosinophils and mild ductular proliferation are seen within the portal tract. (B) Local infiltration of inflammatory cells within the lobules and damaged hepatocytes are seen, indicating lobular hepatitis.

• 

  Fig. 2. Clinical course of the patient.

Reference

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