Volume 5, Number 9; February 06, 2006
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Volume 5, Number 9; February 06, 2006 |
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39-year-old Filipino female with shortness of breath and swollen leg.
Recommended reading:
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Patient:
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Session Handout:
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Clinical Question: 1) W
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Readings:
Link Directly to Fulltext article in Ovid Link Directly to Fulltext Article at Publisher Link Directly to Fulltext Article at Science Direct Fulltext Available in MDConsult using Journal Search and the search term: 98269609 Fulltext Available in EBSCOHost Academic Search Premier Link Directly to Fulltext Article Free on the Internet
<1> Unique Identifier [PMID]: 10548349 Authors: Viallard JF. Tabarin A. Neau D. Longy-Boursier M. Institution: Clinique de Medecine Interne et Maladies Infectieuses, Hopital Haut-Leveque, Pessac, France. Title: Hyperthyroidism with severe intrahepatic cholestasis.
Source: Digestive Diseases & Sciences. 44(10):2001-2, 1999 Oct. Publication Type: Case Reports. Journal Article.
<5> Unique Identifier [PMID]: 7548816 Authors: Huang MJ. Liaw YF. Institution: Division of Endocrinology, Chang Gung Memorial Hospital, Taipei, Taiwan. Title: Clinical associations between thyroid and liver diseases. [Review] [70 refs]
Source: Journal of Gastroenterology & Hepatology. 10(3):344-50, 1995 May-Jun. Abstract: The liver has an important role in thyroid hormone metabolism and the level of thyroid hormones is also important to normal hepatic function and bilirubin metabolism. Besides the associations between thyroid and liver diseases of an autoimmune nature, such as that between primary biliary cirrhosis and hypothyroidism, thyroid diseases are frequently associated with liver injuries or biochemical test abnormalities. For example, thyroid diseases may be associated with elevation of alanine aminotransferase and alkaline phosphatase, which is mainly of bone origin, in hyperthyroidism and aspartate aminotransferase in hypothyroidism. Liver diseases are also frequently associated with thyroid test abnormalities or dysfunctions, particularly elevation of thyroxine-binding globulin and thyroxine. Hepatitis C virus infection has been connected with thyroid abnormalities. In addition, antithyroid drug therapy may result in hepatitis, cholestasis or transient subclinical hepatotoxicity, whereas interferon (IFN) therapy in liver diseases may also induce thyroid dysfunctions. These thyroid-liver associations may cause diagnostic confusions. Neglect of these facts may result in over of under diagnosis of associated liver or thyroid diseases and thereby cause errors in patient care. It is suggested to measure free thyroxine (FT4) and thyroid-stimulating hormone (TSH) which are usually normal in euthyroid patients with liver disease, to rule out or rule in coexistent thyroid dysfunctions, and consider the possibility of thyroid dysfunctions in any patients with unexplained liver biochemical test abnormalities. It is also advisable to monitor patients with autoimmune liver disease or those receiving IFN therapy for the development of thyroid dysfunctions, and patients receiving antithyroid therapy for the development of hepatic injuries. [References: 70] Publication Type: Journal Article. Review.
<8> Unique Identifier [PMID]: 1564300 Authors: Fong TL. McHutchison JG. Reynolds TB. Institution: University of Southern California School of Medicine, Los Angeles. Title: Hyperthyroidism and hepatic dysfunction. A case series analysis.
Source: Journal of Clinical Gastroenterology. 14(3):240-4, 1992 Apr. Abstract: Liver dysfunction in hyperthyroid patients has not been well characterized. We analyzed the clinical records of 43 patients with hyperthyroidism to define the spectrum of clinical and liver test abnormalities. The patients were divided into three categories: (a) 18 patients with uncomplicated hyperthyroidism (HT) (b) 19 with hyperthyroidism and congestive heart failure (HT/CHF), and (c) 6 with hyperthyroidism and concomitant unrelated liver disease (HT/ULD). Hepatomegaly and/or spenomegaly were noted in 15 of 19 (79%) patients with HT/CHF as compared to 6 of 18 (33%) patients with HT and 3 of 6 (50%) patients with HT/ULD. Four patients with HT/CHF had ascites. Serum aminotransferase levels greater than 250 IU/L were noted in only 1 of 37 (3%) patients without unrelated liver disease. Patients with HT/ULD or HT/CHF had markedly low prothrombin time. Serum bilirubin levels as high as 323 microM were noted in patients with HT. No characteristic liver histology due to hyperthyroidism was noted. Severe liver test abnormalities, including deep jaundice and prolonged prothrombin time, can occur in patients with hyperthyroidism alone or with HT/CHF. This makes the diagnosis of concomitant, unrelated liver disease difficult until the hyperthyroidism has been controlled. Publication Type: Journal Article.
<9> Unique Identifier [PMID]: 1943501 Authors: Sola J. Pardo-Mindan FJ. Zozaya J. Quiroga J. Sangro B. Prieto J. Institution: Department of Pathology, Clinica Universitaria de Navarra, Faculty of Medicine, Pamplona, Spain. Title: Liver changes in patients with hyperthyroidism.
Source: Liver. 11(4):193-7, 1991 Aug. Abstract: We studied liver changes in the hepatic biopsies of five patients with hyperthyroidism. A characteristic histopathologic picture consisting of mild to moderate intrahepatocytic cholestasis, lobular inflammatory infiltrate with some eosinophils, and Kupffer cell hyperplasia was found in all cases. We discuss the specificity, clinicopathological correlations and the possible pathophysiology of these lesions. Publication Type: Journal Article.
<18> Unique Identifier [PMID]: 5553951 Authors: Klion FM. Segal R. Schaffner F. Title: The effect of altered thyroid function on the ultrastructure of the human liver.
Source: American Journal of Medicine. 50(3):317-24, 1971 Mar. Publication Type: Journal Article.
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Resident Report / Department of Medicine & Grady Branch Library Emory University School of Medicine 2005 Edition Participating Faculty: Carlos Del Rio MD / Joyce Doyle MD / Lorenzo Difrancesco MD / Erich Folch MD / Alicia Hidron MD
Contact:
Karl Woodworth
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