title: A case of autoimmune hepatitis combined with Graves' disease.
abstract: A 25-year-old woman presented with jaundice, palpitation, and weight loss of 5 kg during a period of 2 weeks. Laboratory tests showed elevated levels of liver enzymes (AST 1,282 IU/L, ALT 1,119 IU/L) and total bilirubin (6.4 mg/dL); negative for hepatitis virus infection; elevated serum levels of triiodothyronine (T3, 3.60 ng/dL), free thyroxine (fT4, 3.82 ng/dL), and lowered serum level of thyroid stimulating hormone (TSH, <0.025 μIU/mL); and positive for thyroid stimulating antibody and anti-mitochondrial antibody (AMA). The liver biopsy findings were consistent with autoimmune hepatitis (AIH). Accordingly, oral steroid therapy was started with 60 mg of prednisolone under the impression of AIH associated with Graves' disease. After a week of steroid therapy, the clinical manifestation showed significant improvement, with normalization of both liver and thyroid functions. Diagnosis of the liver condition of patients who present with hyperthyroidism and liver dysfunction is important, so that appropriate therapy can be promptly initiated.
authors.affiliation: Departments of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Jhee
authors.affiliation: Departments of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Departments of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Wonseok
authors.initials: W
authors.lastname: Kang
authors.affiliation: Departments of Pathology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sewha
authors.initials: S
authors.lastname: Kim
authors.affiliation: Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000032:analysis; D000974:Antibodies, Antinuclear / Q000097:blood; D001219:Aspartate Aminotransferases / Q000032:analysis; D001663:Bilirubin / Q000097:blood; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D008099:Liver / Q000201:enzymology / Q000378:metabolism / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D013972:Thyrotropin / Q000097:blood
chemical_list: D000974:Antibodies, Antinuclear; D018828:Immunoglobulins, Thyroid-Stimulating; D013256:Steroids; D013972:Thyrotropin; D011239:Prednisolone; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin