A 40-Year-Old Woman Who Developed Jaundice during Therapy for Thyrotoxicosis 英文参考文献.docVIP

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A 40-Year-Old Woman Who Developed Jaundice during Therapy for Thyrotoxicosis 英文参考文献.doc

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A 40-Year-Old Woman Who Developed Jaundice during Therapy for Thyrotoxicosis 英文参考文献

Learning Forum A 40-Year-Old Woman Who Developed Jaundice during Therapy for Thyrotoxicosis Chukwuma Ogbonna Ekpebegh, Naomi Sharlene Levitt* What Is the Differential Diagnosis of Jaundice in a Patient with Thyrotoxicosis? D E S C R I P T I O N o f C A S E A Several causes of jaundice should be entertained in this patient. The aetiology may be multifactorial. The differential diagnosis of this patient’s jaundice can be divided into (1) thyrotoxicosis per se and conditions associated with autoimmune thyroid disease, including thionamide therapy, hepatic congestion from thyrotoxic heart failure, hepatic necrosis from systemic embolisation caused by atrial ?brillation, autoimmune hepatitis, and primary biliary cirrhosis, which may be associated with Graves disease, and (2) causes of jaundice unrelated to thyrotoxicosis, such as viral hepatitis, sepsis, cholangitis, alcohol abuse, and medication such as hormonal contraceptives, acetaminophen, isoniazid, rifampicin, and herbal remedies. The pattern of liver function test abnormalities may suggest an aetiology for the jaundice. While hepatocellular damage is classically characterised by elevated serum transaminase levels with minimal increase in serum alkaline phosphatase (hepatocellular pattern), the converse is the case with obstructive causes of jaundice (obstructive pattern). However, many conditions that cause jaundice give a mixed hepatocellular/obstructive pattern. 40-year-old woman presented to a tertiary-care facility on the 11th of October 2004, having been referred from a private-health clinic for continued treatment of thyrotoxicosis. The referring doctor had started her on carbimazole, 60 mg daily 11 months earlier. She discontinued treatment after three months for ?nancial reasons. She was referred to the state tertiary facility because the fees there are subsidized. At presentation on the 11th of October 2004, she had no overt symptoms of hyperthyroidism. Physical examination revealed a well-looking wo