Hepato-renal manifestation of untreated severe hypothyroidism

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Authors: X. Faktorová ¹ ; Zelinková Z. ¹; Horniaková L. ²; Havranová A. ³; Trejbalová Ľ. ⁴; Z. Ďurkovičová ² ; M. Szántová ²
Authors‘ workplace: Interná klinika SZU a UN – Nemocnica svätého Michala, a. s., Bratislava ¹; III. interná klinika LF UK a UN Bratislava ²; I. rádiologická klinika LF UK, SZU a UN Bratislava ³; I. interná klinika SZU v Bratislave ⁴
Published in: Gastroent Hepatol 2022; 76(2): 127-130
Category: Case Report
doi: https://doi.org/10.48095/ccgh2022127

Overview

Primary hypothyroidism based on autoimmune thyroiditis is one of the most common thyroid diseases in countries which sufficient iodine intake. It is 5-times more common in women. We report a rare case of hepatopathy in unrecognized severe hypothyroidism. A 46-years -⁠ -old man was sent to the hospital by his general practitioner for increased hepatic enzymes during a preventive check-up, with a 2-month history of pain in the right hypochondrium. Laboratory examination showed a 4-fold increase in transaminases and a 7-fold increase in cholestatic enzymes, with positivity for ANA, p-ANCA and aTPO autoantibodies, mild hemolytic anemia, a slight increase in creatinine. Imaging methods (USG, CT, MRCP) showed hepatosplenomegaly and bilateral fluidothorax. The diagnosis was established after excluding infectious, metabolic, toxic and oncological etiology and by confirming extremely high level of TSH with reduced fT4 and fT3. Due to autoimmune presentation and suspected ANCA vasculitis, a kidney biopsy was performed, showing no pathology. Treatment with levothyroxine and hepatoprotective agents led to a rapid resolution of difficulties and normalization of laboratory parameters within 5 months of starting treatment. This case report highlights the need for considering the rare etiology of hepatopathy in chronic untreated hypothyroidism.

Keywords:

Hypothyroidism – autoimmune thyroiditis – hepatopathy

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