Korean J Gastroenterol.  2018 Jun;71(6):354-358. 10.4166/kjg.2018.71.6.354.

A Case of Graves' Disease Accompanied with Acute Hepatitis A Virus Infection

Affiliations
  • 1Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea. miunorijw@hallym.or.kr
  • 2Department of Internal Medicine, Seoul Women's Hospital, Incheon, Korea.

Abstract

Concurrent presentation of acute hepatitis A virus (HAV) infection and Graves' disease has not been reported in literature worldwide. Although there is no well-established mechanism that explains the induction of Graves' disease by HAV to date, our case suggests that HAV infection may be responsible for inducing Graves' disease. A healthy 27-year-old female presented fever, palpitation, and diarrhea, and she was subsequently diagnosed as acute HAV infection. Concurrently, she showed hyperthyroidism, and the diagnosis was made as Graves' disease. She had never had symptoms that suggested hyperthyroidism, and previous thyroid function test was normal. Acute HAV infection was recovered by conservative management, however, thyroid dysfunction was maintained even after normalization of liver enzymes. Methimazole was used to treat Graves' disease. We report a case of concurrent acute HAV infection and Graves' disease in a patient without preexisting thyroid disease. This suggests that HAV infection may be a trigger for an autoimmune thyroid disease in susceptible individuals.

Keyword

Hepatitis A virus; Graves disease; Triggering factor

MeSH Terms

Adult
Diagnosis
Diarrhea
Female
Fever
Graves Disease*
Hepatitis A virus*
Hepatitis A*
Hepatitis*
Humans
Hyperthyroidism
Liver
Methimazole
Thyroid Diseases
Thyroid Function Tests
Thyroid Gland
Methimazole

Figure

  • Fig. 1 Liver sonography showed normal echogenecity of the liver, diffuse GB wall thickening, and enlarged lymph node indicated by asterisk mark in hepatic hilum. This finding suggests a reactive change due to acute hepatitis. GB, gallbladder.

  • Fig. 2 Serial changes of ALT & total bilirubin level. ALT was decreased rapidly at the early stage of the disease, and recovered at 9 months. Total bilirubin reached its peak at HD 9, but declined thereafter. Methimazole was taken for the first time, just after the 3rd week. ALT, alanine transaminase; HD, hospital day means the number of days since the admission.

  • Fig. 3 Follow-up of thyroid function tests. Thyrotoxicosis had improved apparently after taking methimazole. TSH, thyroid stimulating hormone; HD, hospital day means the number of days since the admission.


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