methimazole and Hepatitis-A

Concurrent presentation of acute hepatitis A virus (HAV) infection and Graves' disease has not been reported in literature worldwide. Although there is no well-established mechanism that explains the induction of Graves' disease by HAV to date, our case suggests that HAV infection may be responsible for inducing Graves' disease. A healthy 27-year-old female presented fever, palpitation, and diarrhea, and she was subsequently diagnosed as acute HAV infection. Concurrently, she showed hyperthyroidism, and the diagnosis was made as Graves' disease. She had never had symptoms that suggested hyperthyroidism, and previous thyroid function test was normal. Acute HAV infection was recovered by conservative management, however, thyroid dysfunction was maintained even after normalization of liver enzymes. Methimazole was used to treat Graves' disease. We report a case of concurrent acute HAV infection and Graves' disease in a patient without preexisting thyroid disease. This suggests that HAV infection may be a trigger for an autoimmune thyroid disease in susceptible individuals.

Topics: Adult; Alanine Transaminase; Antithyroid Agents; Bilirubin; Female; Graves Disease; Hepatitis A; Humans; Hyperthyroidism; Liver; Methimazole; Thyroid Function Tests

Hyperthyroidism has been associated with liver function abnormalities; however, cholestasis as the presenting feature of adolescent Graves' disease has not been previously reported.. The patient was a 17-year-old girl who presented with severe cholestasis and was found to have Graves' disease. She also had a positive hepatitis A immunoglobulin M antibody but her clinical course, the liver histopathology, and her mildly elevated transaminases indicated that the acute hepatitis A infection was not dominant at the time of presentation with severe cholestasis. Other causes of cholestasis, including congestive heart failure, autoimmune hepatitis, and viral infection, were excluded. Treatment with methimazole resolved the hyperthyroidism, and the cholestasis improved, as well.. Severe cholestasis is a rare presenting feature of Graves' disease. With careful monitoring, methimazole can be used to treat the hyperthyroidism in the setting of cholestasis.

Topics: Adolescent; Adrenergic beta-Antagonists; Antithyroid Agents; Bilirubin; Cholestasis; Female; Graves Disease; Hepatitis A; Hepatitis A Antibodies; Humans; Immunoglobulin M; Liver Function Tests; Methimazole; Propranolol; Thyroid Function Tests

Topics: Antithyroid Agents; Chemical and Drug Induced Liver Injury; Hepatitis; Hepatitis A; Humans; Methimazole; Physiological Phenomena