Liver Injury Induced by Levothyroxine in a Patient with Primary Hypothyroidism

[helvella]

Another perplexing case of a patient suffering liver injury.

This report discusses use of desiccated thyroid and liothyronine.

Again the suggestion that the problem is hapten-based.

Liver Injury Induced by Levothyroxine in a Patient with Primary Hypothyroidism

Tomotaka Kawakami1, Atsushi Tanaka1, Shinichiro Negoro1, Yoshihiko Morisawa1, Masaki Mikami1, Makoto Hojo1, Takatsugu Yamamoto1, Satoko Uegaki1, Mitsuhiko Aiso1, Takahiro Kawasaki1, Taro Ishii1, Yasushi Kuyama1, Toshio Fukusato2 and Hajime Takikawa1

Abstract

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.

Key words: levothyroxine, drug-induced liver injury (DOI: 10.2169/internalmedicine.46.0086)

Open access here:

jstage.jst.go.jp/article/in...

See also these other posts here:

Liver injury induced by levothyroxine tablets in a patient with hypothyroidism

healthunlocked.com/thyroidu...

Occurrence of thyroxine tablet (Thyradin S(®)) - induced liver dysfunction in a patient with subclinical hypothyroidism.

healthunlocked.com/thyroidu....

[inthedoldrums]

Gosh, that is really interesting I will have to put it on the back burner for a while before I read it fully though.

My interest is that in the unpleasant run up to finally being really ill on Levo after 2 years on it., I felt very 'liverish' and could not tolerate oily or fatty foods at all and felt sick a lot of the time. My complexion had a slightly yellow look it seemed too.

It took about six months after stopping Levo for that part of my system to recover and for my appetite to gradually recover. During that time I lost a lot of weight and could only tolerate small light meals like scrambled eggs, mashed potatoes, rice etc.

Maybe another little piece in my jigsaw.

Thank you.

[Janine159 in reply to inthedoldrums]

I saw my liver test results showed a bit out of the reference range it never ever has been in my life. The lab had recommended a retest be done. But I think as the Dr rang with my results last week and never said anything but your tests are ok .I guess they decided it didn't matter . I have asked about why not retesting. They decide that it's not important I suppose . Why do labs recommend things then it doesn't happen x