Abstract
A 54-year-old man was admitted to the hospital because of poor glycemic control, liver dysfunction and elevation of the serum level of creatine kinase. Although the patient was under treatment with glimepiride for diabetes, his blood glucose level was 323 mg/dl and HbA1c was 10.7%. The BMI was 29.9 kg/m2 and waist circumference, 91 cm. The patient was also diagnosed to have hypertension and fatty liver. At admission, thyroid function test results revealed marked hypothyroidism (TSH 135.7 μU/ml, FT4 0.1 ng/dl, FT3 1.49 pg/ml) and the serum was positive for anti-thyroid peroxidase antibody and anti-thyroglobulin antibody. Thus, the patient was diagnosed to have Hashimoto's thyroiditis. Administration of levothyroxine sodium resulted in improvement of the patient's thyroid function test results. To clarify the reason for the liver dysfunction, a percutaneous liver biopsy was performed. The histological findings were compatible with a diagnosis of nonalcoholic steatohepatitis (NASH) (the patient did not have a history of alcohol abuse). Administration of ursodesoxycholic acid and insulin therapy resulted in improvement of the glycemic control and liver function. Type 2 diabetes mellitus is an important risk factor for the development of NASH. In addition, hypothyroidism due to Hashimoto's thyroiditis was also thought to be involved in the pathogenesis of NASH in this case.
