Endocrine Abstracts

34 years old male patient was admitted to Endocrine department with palpitation (130–140 beats/minute), weight loss(15 kg during 3 months), anxiety, nervousness, hand tremor, generalized nocturnal pruritus. Laboratory examination showed: decreased level of thyroid stimulating hormone (TSH) <0.005 (n 0.3–4.0 iu/ml), markedly increased level of free thyroxin (FT4) - 100(n 12–22 pmol/l), free triiodthryonine FT3-6,5 (n-0,8-2,0 ng/ml),anti-R-TSH 15-(n- <1,75T, Anti –TPO 1000,0 (n->34). Glucose and other blood tests ALAT, ASAT,creatinine, ammonia were within normal range.Thyroid ultrasound showed bilaterally enlarged gland with volume of 50 ml, without nodules. Presence of<< thyroid inferno>>. Patient was diagnosed Grave’s thyrotoxicosis. Follow up after 3 weeks of treatment with Thyrazol 50 mg per day, Anaprilin 160 mg 4 times per day, Mirtazapine 7,5 mg showed:weight gain 5 kg, pulse 90–100 beats/minute, absence of nocturnal pruritus after Miratzapine. Laboratory follow up: FT4 40,0, (n-12–22 pmol/l)T3 4,5 ng/ml(n-0,8-2,0 ng/ml). Treatment continued with same daily dose of Thyrazol and Anaprilin 120 mg.Mirtazapine canceled. After 4 weeks patient had weight loss 2,5 kg, palpitation 110–120 beats/minute, abdominal pain, diarrhea, jaundice. Abdominal ultrasonography showed few small calcifications on the right lobe of liver. Laboratory follow up showed increased (AlAT)150 U/l, increased Total Bilirubin 2,5(n-0,2-1,2 mg/dl) and elevated FT4() -105 pmol/l. Hepatitis are checked: Hepatitis C and A were negative.HBsAg 1081,55 S/CO. HBV quantitative 108 IU/ml. It appeared patient had teeth removal one year ago. After consultation with infectionsit anti viral treatment didn’t prescribed. Taiking in account presence of hepatitis B, alcoholism, hepatotoxicity of Thyrazol, heigh level of anti-R TSH, Thyrazol canceled and patient prepared for total thyroidectomy as Radioiodine therapy is unavailable in Armenia.Patient was given lyugol solution for 10 day 7 dropss per day and b –blocker.After 10 day FT4 became 24 pmol/l (n-12-22 pmol/l), Ft3 1,9-(n–0,8-2,0 ng/ml) L. Patient underwent total thyroidectomy than prescribed replacement therapy with L- Thyroxin. One month after FT4- 15 pmol/l, TSH 1,5 IU/ML, ALAT-35 U/I, Total Bilirubin 0,9 mg/dl. Hepatitis markers were within same ranges. Patient’s condition has improved.

Conclusion: Medical treatment of Grave’s disease with presence of Hepatitis B, high level of Anti R-TSH and alcohol addiction can not only aggravate liver disease but bring to recurrence of Grave’s disease.Total thyroidectomy can be a method of chose in this case.