hyperthyroid liver disease
Introduction
Introduction to hyperthyroidism Hyperthyroidism is a liver damage caused by the nail file itself. Clinical manifestations of jaundice, elevated transaminase, loss of appetite, oil, diarrhea and other digestive symptoms. Epidemiology: According to relevant prospective studies, 76% of patients with hyperthyroidism have at least one abnormal liver biochemical indicator before administration. Among them, 64.2% of patients with hyperthyroidism had elevated ALP and 36.8% had elevated ALT. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: respiratory transmission Complications: viral hepatitis A viral hepatitis diarrhea
Cause
Causes of hyperthyroidism
(1) Causes of the disease
1. Direct action of thyroid hormone The liver plays an important role in the metabolism, transformation, excretion and synthesis of thyroid-binding globulin.
2. Hyperthyroidism leads to hypoxia-ischemia of hepatocytes in hypermetabolism.
3. Obstacles to liver energy metabolism.
4. Patients with hyperthyroidism have concurrent infections.
(two) pathogenesis
1. Direct action of thyroid hormone The liver plays an important role in the metabolism, transformation, excretion and synthesis of thyroid-binding globulin. 20% of T4 and T3 are degraded in the liver, combined with glucuronic acid or sulfuric acid, and bile. Discharge into the small intestine, long-term conversion and metabolism of thyroxine increases liver burden, and may directly have toxic effects on the liver.
2. In the hypermetabolism state of hyperthyroidism, the oxygen consumption of hepatocytes increases and the blood flow of liver does not increase correspondingly, resulting in hypoxia-ischemia of hepatocytes.
3. Obstacles to liver energy metabolism, increased metabolic rate in hyperthyroidism, increased consumption of nutrients, increased glycogen decomposition of the liver, lack of protein and vitamins, increased gastrointestinal dysfunction, reduced nutrient absorption, and nutrition Lack of supplementation leads to a lack of liver protection.
4. Congestive heart failure in hyperthyroidism causes hepatic venous congestion and aggravates liver damage.
5. Other hyperthyroidism patients with concurrent infections have adverse effects on the liver under stress or liver damage due to autoimmune reactions.
Prevention
Hyperthyroidism prevention of liver disease
Prevention of prior, regular follow-up, liver function tests before the use of hyperthyroidism in patients with previous history of hepatitis is necessary, because most of the drug-induced liver damage occurs within 3 months of treatment, so within 3 months of starting treatment Follow up the patient, monitor liver function, and inform the patient if there is an anorexia, jaundice and other similar hepatitis symptoms, should seek medical advice immediately.
Complication
Hyperthyroidism liver disease complications Complications Viral hepatitis A virus hepatitis diarrhea
1, the digestive system
(1) Pancreatic disease Acute pancreatitis.
(2) esophagus, gastrointestinal damage esophagitis, esophageal ulcer, lower esophageal varices; gastric ulcer, gastric mucosal damage, stomach bleeding.
(3) Fatty liver is clinically common in the recovery or recovery of acute jaundice hepatitis and chronic hepatitis B or C.
(4) Primary liver cancer type B and hepatitis C virus infection is one of the important causes of primary liver cancer.
2, endocrine and metabolic system complications
(1) Diabetes.
(2) Low blood sugar.
(3) Endocrine damage.
3, blood system complications
(1) Aplastic anemia.
(2) Leukopenia.
(3) Thrombocytopenia.
(4) simple red blood cell aplastic anemia.
(5) Reactive histiocytosis.
(6) hemolytic anemia.
(7) Coagulopathy.
4, circulatory system complications
(1) Heart disease changes 1 peripheral circulation resistance increases. 2 heart rhythm. 3 myocarditis.
(2) vascular lesions 1 nodular polyarteritis is common in patients with hepatitis B. 2 primary cryoglobulinemia (EMC).
5, urinary system complications
(1) Hepatitis-related glomerulonephritis.
(2) renal tubular acidosis.
(3) Acute renal failure.
6, connective tissue and muscle tissue complications
(1) skin lesions acute hepatitis can occur urticaria, angioedema, ring erythema, erythema, maculopapular rash; severe hepatitis can occur defects, ecchymosis, hemorrhoids, facial butterfly erythema, polymorphous erythema, etc.; Itching often occurs in biliary hepatitis; patients with cirrhosis may develop patchy pigmentation in the skin of the lower extremities.
(2) Joint lesions are mostly migratory and symmetrical arthritis.
(3) Muscle disease Chronic hepatitis patients with limb muscle pain are more common, generally lighter.
7, other system complications
(1) Respiratory disease 1 Viral hepatitis can be complicated by exudative pleurisy. 2 In patients with acute liver failure, various toxic substances in the blood cause changes in alveolar permeability, which in turn causes non-cardiogenic pulmonary edema, which is clinically manifested as respiratory distress syndrome.
(2) Neurological disorders 1 Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in severe hepatitis with liver failure. 2 In the early stage of acute hepatitis, some patients may have transient mental symptoms, irritability, irritability, and insomnia.
8, Sjogren's syndrome.
9. Acquired immunodeficiency syndrome (AIDS).
Patients with liver disease must firmly overcome the confidence of the disease. On the one hand, they should improve their awareness and detection awareness, so as to achieve early detection and early treatment.
Symptom
Symptoms of hyperthyroidism with liver disease Common symptoms Loss of appetite, diarrhea, jaundice, bilirubin, elevated hepatic cell necrosis
Astragalus, elevated transaminase, loss of appetite, anaesthesia, diarrhea and other digestive symptoms, no specific performance.
Hyperthyroidism caused by liver damage, including jaundice, elevated liver enzymes, loss of appetite, oil, diarrhea and other digestive symptoms, due to non-specific performance, it should be differentiated from viral hepatitis, liver damage caused by anti-thyroid drugs, The mechanisms and treatments of these three types of liver damage are different, so early diagnosis is particularly important.
1. Hyperthyroidism with hepatitis and hyperthyroidism caused by liver damage have the following differences:
(1) It has nothing to do with the severity of hyperthyroidism.
(2) The digestive system is weak in appetite, and the symptoms of hepatitis such as oil are obvious.
(3) Positive for hepatitis infection markers.
(4) Ineffective anti-thyroid treatment.
2. The diagnosis of anti-thyroid drug-induced liver damage is usually done by exclusion, ie:
(1) Clinical laboratory tests for evidence of liver damage.
(2) The timing of medication and liver damage, that is, liver damage occurs after administration.
(3) Serological evidence of no hepatitis virus infection or autoimmune hepatitis.
(4) No evidence of chronic liver disease.
(5) Other known hepatotoxic drugs are not used at the same time.
(6) Liver function improves or recovers after stopping the drug.
(7) Pathology showed mononuclear cells in the lobule of the liver, and inflammatory infiltration of lymphocytes.
(8) Repeated use of the same drug can cause liver damage again.
Examine
Examination of hyperthyroidism
Hepatitis infection markers are positive.
1. Thyroid B ultrasound.
2. Abdominal B ultrasound.
Diagnosis
Diagnosis and differentiation of hyperthyroidism
It is generally believed that liver damage caused by anti-thyroid drugs is more common within 3 months after administration. Liver damage caused by PTU is mainly caused by different degrees of hepatocyte necrosis, while MMI liver damage is mainly caused by intrahepatic cholestatic, ie hepatocytes and (or) bile duct cholestatic, the former mainly showed elevated transaminase, the latter mainly showed elevated bilirubin.
Because of the non-specific manifestations of hyperthyroidism, it should be differentiated from viral hepatitis and liver damage caused by antithyroid drugs.
