Endocrine Abstracts (2017) 49 EP1264 | DOI: 10.1530/endoabs.49.EP1264

Early diagnosis of primary biliary cirrhosis during follow-up for Graves' disease

Sevgul Faki1, Muhammet Cuneyt Bilginer1, Cevdet Aydin1, Didem Ozdemir1, Husniye Baser2, Osman Ersoy3, Reyhan Ersoy1 & Bekir Cakir1

1Department of Endocrinology and Metabolism, Yildirim Beyazit University, School of Medicine, Ankara, Turkey; 2Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital Education and Research Hospital, School of Medicine, Ankara, Turkey; 3Department of Gastroenterology, Yildirim Beyazit University, School of Medicine, Ankara, Turkey.

Introduction: Hepatic dysfunction in hyperthyroidism may occur due to high thyroid hormones, medications or associated autoimmune liver disease. Autoimmune hepatitis or primary biliary cirrhosis (PBC) has rarely been reported in Graves’ disease. We report a patient presenting with pruritus and diagnosed as accompanying PBC and Graves’ disease.

Case: A 50 years old female patient applied with progressive pruritus for at least 4 months. Laboratory investigations showed normal alanine aminotransferase and aspartate aminotransferase. Serum alkaline phosphatase (ALP) was 125 IU/l (≤105 IU/l), gamma glutamyl transferase (GGT) was 132 IU/l (≤42), and total serum bilirubin and conjugated bilirubin were within normal ranges. She had low TSH (<0.005 U/l) and high serum free T4 (4.6 ng/dl) and free T3 (14.71 pg/ml). Thyroid peroxidase antibody and thyroid stimulating hormone receptor antibody were also positive. She was afebrile and had regular pulse rate of 110/min and normal blood pressure. There was no exophthalmus, goiter, hepatomegaly or splenomegaly in physical examination. Ultrasonographically, the thyroid gland was enlarged with increased vascularity. Technetium-99m scintigraphy showed increased activity throughout the gland with cold nodules in an enlarged thyroid gland. She was started on methimazole and propranolol. After a week of treatment, her ALP and GGT levels raised to 160 and 151, respectively that we discontinued methimazol. Serology tests for viral hepatitis, human immunodeficiency virus and cytomegalovirus were negative; laboratory tests excluded copper, iron-related metabolic disorders and autoimmune liver diseases. Anti-mitochondrial antibody was found positive and PBC was diagnosed with clinical and laboratory findings. She was started on ursodeoxycholic acid and underwent bilateral total thyroidectomy.

Conclusion: PBC is often associated with other autoimmune diseases. When a cholestatic pattern of liver enzymes is observed during follow-up for Graves’ disease, PBC should be considered in the differential diagnosis.

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