Liver injury induced by levothyroxine in a patient with primary hypothyroidism.
We report a patient with primary hypothyroidism, who developed hepatocellular injury due to levothyroxine, synthetic thyroxine. A 63-year-old male was admitted to our hospital due to elevation of liver enzymes. The patient was diagnosed as having hypothyroidism and had been treated with levothyroxine for almost two months until admission. Drug-induced liver injury induced due to levothyroxine was suspected and liver enzymes were rapidly decreased after discontinuation of levothyroxine and dried thyroid powder, also containing thyroxine. Synthetic triiodothyronine, the deiodinated form of levothyroxine was administered instead, and was well tolerated by the patient. The drug-induced lymphocyte stimulation test (DLST) using levothyroxine was negative. Since triiodothyronine which structurally resembles levothyroxine did not cause liver injury, and DLST using levothyroxine was negative, it is unlikely that levothyroxine itself was targeted by the immune system. Rather, we assume that the complex of levothyroxine as the hapten and liver-related macromolecules in the body as the carrier might have acquired antigenicity in this patient and subsequently resulted in liver injury.
Kawakami
Tomotaka
T
Department of Medicine, Teikyo University School of Medicine, Tokyo.
Tanaka
Atsushi
A
Negoro
Shinichiro
S
Morisawa
Yoshihiko
Y
Mikami
Masaki
M
Hojo
Makoto
M
Yamamoto
Takatsugu
T
Uegaki
Satoko
S
Aiso
Mitsuhiko
M
Kawasaki
Takahiro
T
Ishii
Taro
T
Kuyama
Yasushi
Y
Fukusato
Toshio
T
Takikawa
Hajime
H
D056486:Chemical and Drug Induced Liver Injury; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000188:drug therapy*; D008107:Liver Diseases / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013974:Thyroxine / Q000009:adverse effects*; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000627:therapeutic use
D014284:Triiodothyronine; D013974:Thyroxine