title: Occurrence of thyroxine tablet (Thyradin S(®)) - induced liver dysfunction in a patient with subclinical hypothyroidism.
abstract: A 54-year-old woman with subclinical hypothyroidism developed liver dysfunction after increasing dose of levothyroxine (L-T4) in tablet form (Thyradin S(®)) from 25μg to 50μg. Viral hepatitis, autoimmune hepatitis and NASH were ruled out with examinations. After cessation of levothyroxine in 50μg tablet form, liver enzymes gradually returned to normal. She was diagnosed levothyroxine-induced liver injury, based on criteria proposed in DDW-J 2004 workshop. Thyradin S(®) powder 0.01% (here in after referred to as L-T4 in powder form) was tried as an alternative, and liver enzymes have remained within normal range. As for Thyradin S(®) tablet, additives are different for each type of levothyroxine sodium content. The difference of additive is whether Fe2O3 is contained or not: it is not included in Thyradin S(®) 50μg tablet and powder form. Although there are two case reports in the Japanese literature and three case reports in the English literature of liver dysfunction suspected due to L-T4, we cannot find past reports about cases of drug induced liver dysfunction due to Fe2O3 free levothyroxine tablet form. This is a rare case report of drug induced liver injury due to Fe2O3 free levothyroxine tablet form, and administration of L-T4 in powder form may be useful for treatment of cases similar to this one.
authors.affiliation: Department of Internal Medicine, Kuma Hospital, Kobe, Japan.
authors.forename: Shino
authors.initials: S
authors.lastname: Kang
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Amino
authors.forename: Takumi
authors.initials: T
authors.lastname: Kudo
authors.forename: Eijun
authors.initials: E
authors.lastname: Nishihara
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ito
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Hirokawa
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tamada
authors.forename: Takenori
authors.initials: T
authors.lastname: Yasuda
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy*; D008875:Middle Aged; D013974:Thyroxine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D013974:Thyroxine