Thiamazole is well known for treatment of Graves' disease, and thiamazole-associated liver injury occurs very rarely. We report a case of hyperthyroidism complicated with drug-induced cholestatic liver injury during treatment with thiamazole.
A 26 year-old male visited our hospital on October 3, 1991 because of mild fever, loss of weight and general fatigue. Because of diffuse goiter and laboratory data indicating hyperthyroidism, a diagnosis of Graves' disease was made, and administration of thiamazole was started on January 9, 1992. From January 20, fever, white watery stool and jaundice developed in a few days, and he was admitted to our hospital on February 3.
Physical examination showed jaundice and goiter, and the blood chemistry test indicated liver injury (GOT 111 IU/1, GPT 196 IU/1, T. Bil 24.3 mg/dl). Viral markers of hepatitis A, B or C virus were negative. An echo examination of the abdomen showed no dilatation of bile ducts. Liver biopsy specimen indicated cholestasis without infiltration of inflammatory cells.
Drug-induced cholestatic liver injury was suspected, and administration of thiamazole was stopped. Afterward, the serum transaminase levels decreased, but jaundice remained. Administration of prednisolone resolved jaundice.
