Liver Injury Induced by Levothyroxine in a Patient with Primary Hypothyroidism
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概要
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We report a patient with primary hypothyroidism, who developed hepatocellular injury due to levothyroxine, synthetic thyroxine. A 63-year-old male was admitted to our hospital due to elevation of liver enzymes. The patient was diagnosed as having hypothyroidism and had been treated with levothyroxine for almost two months until admission. Drug-induced liver injury induced due to levothyroxine was suspected and liver enzymes were rapidly decreased after discontinuation of levothyroxine and dried thyroid powder, also containing thyroxine. Synthetic triiodothyronine, the deiodinated form of levothyroxine was administered instead, and was well tolerated by the patient. The drug-induced lymphocyte stimulation test (DLST) using levothyroxine was negative. Since triiodothyronine which structurally resembles levothyroxine did not cause liver injury, and DLST using levothyroxine was negative, it is unlikely that levothyroxine itself was targeted by the immune system. Rather, we assume that the complex of levothyroxine as the hapten and liver-related macromolecules in the body as the carrier might have acquired antigenecity in this patient and subsequently resulted in liver injury.
著者
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Ishii Taro
Department Of Internal Medicine Teikyo University Hospital
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AISO MITSUHIKO
Department of Medicine, Teikyo University School of Medicine
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Fukusato Toshio
Department Of Pathology Gunma University Hospital
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Yamamoto Takatsugu
Department Of Internal Medicine School Of Medicine Teikyo University
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Morisawa Yoshihiko
Department Of Internal Medicine Teikyo University Hospital
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Kuyama Yasushi
Department Of Internal Medicine School Of Medicine Teikyo University
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Kawakami Tomotaka
Department Of Internal Medicine School Of Medicine Teikyo University
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Hojo Makoto
Department Of Chemistry Graduate School Of Pure And Applied Sciences University Of Tsukuba
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Aiso Mitsuhiko
Department Of Medicine Teiukyo University School Of Medicine
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Takikawa Hajime
Department Of Internal Medicine Teikyo University Hospital
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Uegaki Satoko
Department Of Gastroenterology Tokyo Metropolitan Geriatric Hospital
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Kawasaki Takahiro
Department Of Internal Medicine Teikyo University School Of Medicine
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Mikami Masaki
Department Of Medicine Teikyo University School Of Medicine
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Tanaka Atsushi
Department Of Cardiology Kariya Toyota General Hospital
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Negoro Shinichiro
Department Of Medicine Teikyo University School Of Medicine
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Kawasaki Takahiro
Department of Medicine, Teikyo University School of Medicine
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Yamamoto Takatsugu
Department of Medicine, Teikyo University School of Medicine
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