Objectives: A variety of causes can lead to cholestasis, however, cholestasis caused by Graves' disease is usually overlooked clinically. Here we analyze the clinical characteristics of Graves' disease associated cholestasis so as to have a better understanding for the disease.
Methods: We retrospectively collected 13 inpatients' data who suffered from the Graves' disease associated cholestasis in the Department of Infectious Disease of Xiangya Hospital from January 2000 to December 2018. The characteristics of the patients' age, gender, liver function, thyroid function, coagulation function, the special cardiac examination, treatment, and follow-up data were analyzed.
Results: Thirteen patients, including 10 males and 3 females with the age range from 33 to 55 (median 43) years old presented cholestasis, pruritus, and hypermetabolic symptoms. The levels of total bilirubin (TBIL), direct bilirubin (DBIL), glutamic-pyruvic transferase, glutamic-oxaloacetic transferase, alkaline phosphosphatase, and gamma glutamyl transpeptidase were 170.4-976.7 (median 388.8) µmol/L, 93.2-418.1 (median 199.2) µmol/L, 25.1-182.1 (median 106.4) U/L, 38.2-265.7 (median 59.7) U/L, 105.3-332.0 (median 184.5) U/L, and 20.7-345.1 (median 47.6) U/L, respectively. The levels of free triiodothyronine (FT3), free thyroxine (FT4), and thyrotrophin receptor antibody were 4.1-50.0 (median 21.6) pmol/L, 30.4-100.0 (median 87.9) pmol/L, and 4.2-40 (median 19.8) U/mL, respectively. All patients' coagulation function, heart size, and ejection fraction (EF) value were normal. After anti-thyroid treatment, the levels of FT3, FT4, and TBIL decreased. Through telephone interview, we were able to know that after 6 months of anti-thyroid treatment, the level of FT3, FT4, and TBIL in these patients returned to normal, and the itch symptom disappeared completely.
Conclusions: Graves' disease can cause cholestasis, with the low incidence. The symptoms of cholestasis can be improved or even eradicated with the cure of the Graves' disease. The cholestasis may be idiopathic. For patients with cholestasis and hyperthyroidism, Graves' disease should be considered for differential diagnosis.
目的: 多种原因可导致胆汁淤积，而由Graves病引起的胆汁淤积在临床上极易被忽视。本研究旨在分析Graves病相关性胆汁淤积的临床特点，以提高对该种临床综合征的认识及诊治水平。方法: 回顾性分析2000年1月至2018年12月入住湘雅医院感染科的Graves病相关性胆汁淤积症的13例患者，收集并分析其年龄、性别、肝功能、甲状腺功能、凝血功能、心脏特殊检查、治疗情况及随访资料。结果: 13例患者中男10例，女3例，年龄33~55(中位数43)岁，均有黄疸、瘙痒及高代谢症状。入院时实验室检查示：总胆红素(total bilirubin，TBIL)170.4~976.7(中位数388.8) µmol/L，直接胆红素(direct bilirubin，DBIL)93.2~418.1(中位数199.2) µmol/L，谷丙转氨酶25.1~182.1(中位数106.4) U/L，谷草转氨酶38.2~265.7(中位数59.7) U/L，碱性磷酸酶(alkaline phosphatase，ALP)105.3~332.0(中位数184.5) U/L，谷氨酰基转移酶20.7~345.1(中位数47.6) U/L；游离三碘甲腺原氨酸(free triiodothyronine，FT3)为4.1~50.0(中位数21.6) pmol/L，血清游离甲状腺素(free thyroxine，FT4)为30.4~100.0(中位数87.9) pmol/L，促甲状腺激素受体抗体为4.2~40(中位数19.8) U/mL；患者凝血功能、射血分数及心脏大小正常。经抗甲状腺功能亢进治疗后，患者的FT3和FT4下降，TBIL明显降低。通过电话询问患者出院后6个月皮肤症状及甲状腺功能和肝功能检查结果，所有患者FT3、FT4及TBIL恢复正常，皮肤瘙痒症状消失。结论: Graves病相关性胆汁淤积症发病率低。随着Graves病的有效控制，胆汁淤积可明显好转乃至消失。Graves病引起的胆汁淤积可能为体质特异性，对于甲状腺功能亢进的胆汁淤积表现者的鉴别诊断应将Graves病考虑在内。.
Keywords: Graves’ disease; Graves’ disease associated cholestasis; cholestasis; clinical manifestation; diagnosis; treatment.