A male case of lupoid hepatitis complicated with chronic thyroiditis (Hashimoto's thyroditis)

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A case of lupoid hepatitis complicated with chronic thyroiditis (Hashimoto's thyroiditis) was reported in a 50-year-old man who was admitted with a chief complaint of lassitude and had diffuse enlargement of the thyroid gland and hepatomegaly. Laboratory findings were as follows; s-GOT 43; s-GPT 59; T. Chol 107mg/dl; Ch. E 0.2 ΔpH; s-Alb 3.3g/dl; γ-gl 3.1g/dl. Immunological tests were positive for rheumatoid factor, LE cell phenomenon and antinuclear antibody, with a high titer of antithyroglobulin antibodies. The liver biopsy specimen showed evidence of chronic active hepatitis with formation of lymphoid follicles and a tendency to lobular reorganization. The thyroid biopsy specimen showed microscopic features characteristic of Hashimoto's thyroiditis. The case presented clinical features of what has been called the hepato-thyroiditis syndrome; some autoimmune mechanisms might underlie the pathogenesis of the liver disorder as well as that of the thyroiditis. The patient being a heavy alcohol drinker had chronically lowered serum T. cholesterol, s-Alb and Ch. E levels and the disease continued to progress despite corticosteroid therapy. Serial liver biopsy examinations consistently showed histologic findings indicative of alcoholic liver injury. Therefore, it appeared likely that his chronic alcoholic ingestion served as a direct or indirect extrinsic triggering and loading factor.