Suffer from hyperthyroidism, liver function abnormalities do not be afraid

*For medical professionals only

The liver is an important place for drug metabolism

Patients with hyperthyroidism (referred to as hyperthyroidism) often have liver damage, which is manifested as abnormal liver function, and the incidence can reach 37.
9%, of which liver damage caused by hyperthyroidism alone accounts for about 65.
6%.

Some people have conducted retrospective analysis of cases of hospitalized hyperthyroidism patients, and found that nearly 1/3 of patients have elevated transaminases before antithyroid drug treatment, and after antithyroid drug treatment hyperthyroidism control, transaminases have dropped to normal
.
Some patients have normal liver function before treatment, and after taking antithyroid drugs, transaminases are found to be elevated by occasional examination of liver function, indicating that antithyroid drugs may damage the liver and should also be taken seriously
.








Why does hyperthyroidism cause liver damage?
Possible causes are as follows:

• In hyperthyroidism, tissue oxygen consumption increases, and liver oxygen consumption also increases, but liver blood flow does not increase, resulting in relative hypoxia of the liver, causing hepatocyte steatosis, necrosis, liver enlargement, causing transaminases to rise;
• Excessive consumption of hyperthyroid nutrients, especially the consumption of vitamins exceeds the absorption of the body, resulting in nutrient deficiencies in the liver, obstacles to the metabolism of sugar, fat, protein and bile pigments, resulting in hepatocyte degeneration, necrosis and cholestasis;
  
• When hyperthyroidism is complicated by congestive heart failure, hepatic venous congestion and central lobule necrosis of the liver can occur;
  
• Hyperthyroidism combined with infection and shock can aggravate liver damage;
  
• Antithyroid drugs, especially propythiouracil, can cause liver damage and even acute hepatic necrosis
  .
  
  

Hyperthyroidism liver damage is characterized by mild elevation of transaminases and a generally normal jaundice index, which may also be elevated when the following conditions occur:

• Severe hyperthyroidism;
• Those with a long course of illness;
• a history of chronic liver disease in the past, especially long-term carriers of hepatitis B and C viruses;
• Patients with prolonged alcohol consumption;
• accompanied by severe malnutrition, very little eating;
• People
  with co-infection and heart failure.
  

How should it be treated?

Hyperthyroidism with mild hepatic dysfunction is not a contraindication
to antithyroid therapy.
If the patient has a normal appetite and no obvious jaundice, treatment with antithyroid drugs can still be considered, commonly used in drugs
such as methimazole tablets and propythiouracil tablets.

The dose of antithyroid drugs during treatment is slightly reduced, about 2/3-3/4 of the commonly used dose, while closely observing the changes in appetite, weight, jaundice and aminotransferase of the patient, while strengthening nutrition, protecting the liver, oral vitamins, quitting smoking and alcohol, actively treating the existing comorbidities, the liver function of the vast majority of patients improves with the control of hyperthyroidism, and most hyperthyroidism patients also return to normal liver function after the thyroid function returns to normal
.

Patients with hyperthyroidism with moderate to severe liver dysfunction may be considered radionuclide-131 iodine therapy, and liver function in the vast majority of patients will improve
with hyperthyroidism.






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This article was first published Dr.
You talked about the thyroid gland

Responsible editorCao Qian

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