Hyperthyroidism as a Potential Trigger for Benign Recurrent Intrahepatic Cholestasis

Abstract

Benign recurrent intrahepatic cholestasis (BRIC) is a rare genetic disease often causing episodes of jaundice since childhood. Its triggering factors are still unknown. Hyperthyroidism solely is an infrequent cause of jaundice, and it was never described in association with BRIC. In this article, we reported a woman presenting with a new episode of BRIC and was found to have concomitant hyperthyroidism in the absence of any other potential trigger factor. We conclude that hyperthyroidism may trigger cholestasis in patients with BRIC.

Coronavirus disease 2019 (COVID‐19) as a potential trigger for benign recurrent intrahepatic cholestasis

“… 2 , 12 , 13 , 14 , 15 Halawi et al suggested that a case of hyperthyroidism (Graves’ disease) initiated the disease attack in a patient with BRIC. 16 When Zimmer et al investigated the cause of prolonged hyperbilirubinemia in an acute hepatitis E virus (HEV) patient, they found a defect in the underlying ABCB11 gene, treated the patient as for BRIC (ursodeoxycholic acid) and claimed that the BRIC‐like episode was triggered by HEV. 17 Blackmore et al published a case in which lymphoma initiated an attack of intrahepatic cholestasis in a case diagnosed with Hodgkin's lymphoma, in which they detected ABCB11 and ATP8B1 genetic abnormalities.…”

“…It has been published that stress, pregnancy, drugs (oral contraceptives), respiratory tract‐gastrointestinal, and cutaneous infections initiate the attack of BRIC 2,12–15 . Halawi et al suggested that a case of hyperthyroidism (Graves’ disease) initiated the disease attack in a patient with BRIC 16 17 .…”

Benign Recurrent Intrahepatic Cholestasis: Where Are We Now?

“…Beyond pregnancy and oral contraceptive drug use, thyroid dysfunction has been linked to triggering BRIC episodes, with recent reports associating hyperthyroidism with BRIC [43]. Additionally, hypothyroidism has been proposed as an extra-hepatic manifestation of BRIC rather than a direct triggering factor [33].…”

Benign Recurrent Intrahepatic Cholestasis: Where are we now?

“…Estrogens may impact BSEP's function by inhibiting the Farsenoid X Receptor (FXR), a transcription factor via which BSEP is postulated to be involved in the excretion of bile salts [27]. Beyond pregnancy and oral contraceptive drug use, thyroid dysfunction has been linked to triggering BRIC episodes, with recent reports associating hyperthyroidism with BRIC [37]. Additionally, hypothyroidism has been proposed as an extra-hepatic manifestation of BRIC rather than a direct triggering factor [27].…”