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Severe hyperthyroidism without symptoms due to nonthyroidal illness in a child with acute hepatitis: case report and literature review
Annals of the New York Academy of Sciences ( IF 5.2 ) Pub Date : 2020-09-23 , DOI: 10.1111/nyas.14493
Olga Yeliosof 1 , Ian Marshall 1
Affiliation  

While liver enzyme changes are frequently reported in hyperthyroidism, liver dysfunction itself can lead to alterations in thyroid hormone metabolism. However, the exact relationship between hyperthyroidism and liver dysfunction is unclear. We report an 11-year-old boy presenting with acute hepatitis of unknown etiology, who was incidentally found to have asymptomatic biochemical hyperthyroidism. Despite significant total and free T4 elevation, clinical evidence of thyrotoxicosis was absent. Thyroid I-123 uptake was also reduced. Additional testing revealed slight T3 elevation and significant rT3 elevation. Graves' and Hashimoto's thyroiditis testing was negative. We hypothesize that the biochemical hyperthyroidism was due to transient thyroiditis. Although an etiology for the boy's hepatitis was never determined, and an undiagnosed infectious etiology causing subacute thyroiditis was considered, subsequent testing showing positive thyroid peroxidase antibodies, suggesting autoimmune Hashimoto's thyroiditis as the likely cause of the hyperthyroidism. We believe, furthermore, that the absence of symptoms was the result of concurrent nonthyroidal illness resulting in the biochemical findings of slight T3 elevation and significant rT3 increase despite significant T4 elevation.

中文翻译:

儿童急性肝炎非甲状腺疾病引起的无症状重度甲亢病例报告及文献复习

虽然甲状腺功能亢进症中经常报告肝酶变化,但肝功能障碍本身可导致甲状腺激素代谢的改变。然而,甲亢与肝功能障碍之间的确切关系尚不清楚。我们报告了一名 11 岁男孩,他患有不明病因的急性肝炎,偶然发现他患有无症状的生化甲状腺功能亢进症。尽管总 T4 和游离 T4 显着升高,但缺乏甲状腺毒症的临床证据。甲状腺 I-123 的摄取也减少了。其他测试显示 T3 轻度升高和 rT3 显着升高。Graves 和 Hashimoto 的甲状腺炎检测呈阴性。我们假设生化甲亢是由一过性甲状腺炎引起的。虽然男孩肝炎的病因从未确定,考虑到未确诊的感染性病因引起亚急性甲状腺炎,随后的检查显示甲状腺过氧化物酶抗体阳性,提示自身免疫性桥本甲状腺炎可能是甲亢的原因。此外,我们认为没有症状是并发非甲状腺疾病的结果,导致生化发现 T3 轻度升高和 rT3 显着升高,尽管 T4 显着升高。
更新日期:2020-09-23
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