Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (1): 76-81.doi: 10.6040/j.issn.1671-7554.0.2023.0852

• Clinical Medicine • Previous Articles    

Hormones combined with methimazole in the treatment of thyroid crisis with hepatitis B and liver failure: a case report

SONG Xiaoyu1,2, LI Qian2, WANG Lulu2, WANG Xin2, DONG Zhenhua2, PANG Shuguang1,2   

  1. 1. Shandong University, Jinan 250100, Shandong, China;
    2. Department of Endocrinology, Jinan Central Hospital, Shandong First Medical University, Jinan 250013, Shandong, China
  • Published:2024-02-02

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Abstract: Objective To explore the clinical basis of drug effectiveness and safety in the treatment of hyperthyroidism complicated with liver damage, especially in cases of thyroid crisis with hepatitis B and liver failure. Methods A case of hepatic failure complicated with hyperthyroidism with uncontrolled chronic hepatitis B was reported. The course of treatment was described, including hepatoprotective, enzyme-lowering treatment, artificial liver blood purification, antiviral therapy, and glucocorticoid combined with methimazole therapy after thyroid crisis. Results At admission, the patients alanine aminotransferase(ALT)was 534.6 U/L, aspartate aminotransferase(AST)was 597.3 U/L, international normalized ratio(INR)was 1.92, and prothrombin activity(PTA)was 30.7%. After hepatoprotective, enzyme-lowering treatment, the INR was 1.94, and PTA was 30.1%. At this time, thyroid crisis occurred, which was dealt with glucocorticoid and methimazole along with antiviral therapy. After treatment, the ALT was 73.3 U/L, AST was 58.2 U/L, INR was 1.26, and PTA was 70.9%. Conclusion For liver failure caused by hyperthyroidism, the use of methimazole is not contraindicated, since treatment of the primary disease of hyperthyroidism is more effective than supportive treatment of liver protection. In case of thyroid crisis complicated with hepatitis B and liver failure, glucocorticoid can effectively improve hyperthyroidism and liver injury along with antiviral therapy.

Key words: Hyperthyroidism, Thyroid crisis, Hepatitis B, Liver failure, Methimazole

CLC Number: 

  • R581.5
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