propylthiouracil and Hepatitis--Viral--Human

This study investigated the prognostic parameters and beneficial effects of repeat plasma exchange in children with acute liver failure (ALF).. Twenty-three patients under 18 years of age admitted to National Taiwan University Hospital due to ALF from 2003 to 2016 were included in this retrospective analysis.. Among the patients, 11 (48%) had native liver recovery (NLR), 9 (39.1%) died without liver transplant, and 3 (12.9%) received liver transplantation. The NLR group showed a lower proportion of idiopathic cases, lower peak ammonia level, higher peak alpha fetoprotein (AFP) level, and they had plasma exchange fewer times than the other groups. Receiver operating characteristic curve analyses yielded optimal cutoff values of plasma exchange (≤6 times), peak ammonia level (<190 μmol/L), and peak AFP level for predicting NLR in children with ALF.. Pediatric ALF with idiopathic etiology, high peak ammonia level, and low peak AFP level are associated with fewer cases of NLR. Plasma exchange for more than six times probably offers little benefit with regard to patient survival if liver transplantation is not performed promptly.

Topics: Adolescent; alpha-Fetoproteins; Ammonia; Antithyroid Agents; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Female; Hemochromatosis; Hepatitis, Viral, Human; Hepatolenticular Degeneration; Humans; Infant; Infant, Newborn; Liver Failure, Acute; Liver Transplantation; Lymphohistiocytosis, Hemophagocytic; Male; Metabolism, Inborn Errors; Mortality; Plasma Exchange; Prognosis; Propylthiouracil; Recovery of Function; Retrospective Studies; ROC Curve; Taiwan

Topics: Adolescent; Adult; Aged; Antithyroid Agents; Biomarkers; Female; Hepatitis B; Hepatitis, Viral, Human; Humans; Hyperthyroidism; Liver Function Tests; Male; Methimazole; Middle Aged; Propylthiouracil; Retrospective Studies; Severity of Illness Index; Thyroid Function Tests; Young Adult

To evaluate the incidence, severity, and course of propylthiouracil-induced hepatic injury in patients with hyperthyroidism.. Cohort study.. Outpatient clinic of a university-based hospital.. Fifty-four patients with normal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values and a definite diagnosis of hyperthyroidism.. Treatment with propylthiouracil, 300 mg/d for 2 months followed by 100 to 150 mg/d for 3 months and a subsequent maintenance dose of 100 mg/d.. Liver biochemical tests were studied before therapy and 2 months and 5 months after starting propylthiouracil therapy. The patients were monitored with clinical evaluation and weekly liver biochemical tests after AST or ALT levels became abnormal. Serologic markers of hepatitis A, B, C, and delta virus infection were also studied when appropriate.. Fifteen (28%; 95% CI, 16% to 42%) of the 54 patients showed ALT elevations 2 months after propylthiouracil therapy. The mean peak ALT level for these patients was 1.35 mu kat/L (range, 0.65 3.85 mu kat/L). None of these patients had symptoms or hyperbilirubinemia. Liver biopsy in three patients showed mild perivenular focal necrosis or ill-defined granuloma composed of foamy histiocytes with ceroid pigment and mild fatty metamorphosis. Despite continued propylthiouracil therapy at a reduced dose, ALT levels returned to normal in 13 of 15 patients in the following 3 months. None of these ALT elevations resulted from hepatitis A, B, C, or delta virus infection. No statistical difference was seen in the pretreatment characteristics between patients with and those without ALT elevation, except that the former had a higher pretreatment T4 level (270 +/- 12.9 compared with 237 +/- 7.72 nmol/L, P = 0.027) and T3 level (7.22 +/- 0.72 compared with 5.85 +/- 0.39 nmol/L, P = 0.048).. Propylthiouracil-induced subclinical liver injury is common and is usually transient and asymptomatic. Therapy with propylthiouracil may be continued with caution in the absence of symptoms and hyperbilirubinemia.

Topics: Adult; Alanine Transaminase; Chemical and Drug Induced Liver Injury; Clinical Enzyme Tests; Cohort Studies; Female; Hepatitis, Viral, Human; Humans; Hyperthyroidism; Incidence; Liver; Liver Diseases; Male; Propylthiouracil; Severity of Illness Index

Propylthiouracil-induced hepatitis is an uncommon entity. Two further cases are reported herein, and the clinical and laboratory features of the other six cases in the English literature are reviewed. The initial appearance of the disease is similar to that of viral hepatitis, characterized by nausea, vomiting, and jaundice. The biochemical pattern of injury is predominantly hepatocellular, with marked elevation of transaminase valves and less striking elevation of alkaline phosphatase values. Recovery is usually complete after withdrawal of the drug, but there have been at least two fatalities, including the first patient (to our knowledge) whose case is reported herein. Despite its rarity, the disease should be suspected in any patient receiving propylthiouracil in whom clinical or laboratory evidence of hepatocellular injury develops.

Topics: Adult; Antibodies, Antinuclear; Chemical and Drug Induced Liver Injury; Child; Diagnosis, Differential; Female; Graves Disease; Hepatitis B Surface Antigens; Hepatitis, Viral, Human; Humans; Hyperthyroidism; Liver Function Tests; Male; Middle Aged; Propylthiouracil; Serologic Tests