Primary biliary cirrhosis associated with Graves’ disease in a male patient

Suzuki, Yuji; Ishida, Kazuyuki; Takahashi, Hiroshi; Koeda, Norihiko; Kakisaka, Keisuke; Miyamoto, Yukio; Suzuki, Akiko; Takikawa, Yasuhiro

doi:10.1007/s12328-016-0635-x

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…The two kinds of hormone imbalance also occur in cirrhotic patients (Vincken et al, 2017;Punekar et al, 2018). In addition, patients with PBC, an autoimmune liver disease (AILD), are at higher risk for other autoimmune diseases, including autoimmune thyroid disease (AITD), Hashimoto's thyroiditis, and Graves's thyroiditis (Floreani et al, 2015;Suzuki et al, 2016;Zeng et al, 2020). However, the abovementioned relationships between PBC and thyroid dysfunction are obtained based on observational studies, in which reverse causality, selection bias, and especially unobserved confounding factors might mask true causal relationships.…”

Section: Introductionmentioning

confidence: 99%

The Causal Effects of Primary Biliary Cholangitis on Thyroid Dysfunction: A Two-Sample Mendelian Randomization Study

et al. 2021

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Background: Primary biliary cholangitis (PBC) is an autoimmune disease and is often accompanied by thyroid dysfunction. Understanding the potential causal relationship between PBC and thyroid dysfunction is helpful to explore the pathogenesis of PBC and to develop strategies for the prevention and treatment of PBC and its complications.Methods: We used a two-sample Mendelian randomization (MR) method to estimate the potential causal effect of PBC on the risk of autoimmune thyroid disease (AITD), thyroid-stimulating hormone (TSH) and free thyroxine (FT4), hyperthyroidism, hypothyroidism, and thyroid cancer (TC) in the European population. We collected seven datasets of PBC and related traits to perform a series MR analysis and performed extensive sensitivity analyses to ensure the reliability of our results.Results: Using a sensitivity analysis, we found that PBC was a risk factor for AITD, TSH, hypothyroidism, and TC with odds ratio (OR) of 1.002 (95% CI: 1.000–1.005, p = 0.042), 1.016 (95% CI: 1.006–1.027, p = 0.002), 1.068 (95% CI: 1.022–1.115, p = 0.003), and 1.106 (95% CI: 1.019–1.120, p = 0.042), respectively. Interestingly, using reverse-direction MR analysis, we also found that AITD had a significant potential causal association with PBC with an OR of 0.021 (p = 5.10E−4) and that the other two had no significant causal relation on PBC.Conclusion: PBC causes thyroid dysfunction, specifically as AITD, mild hypothyroidism, and TC. The potential causal relationship between PBC and thyroid dysfunction provides a new direction for the etiology of PBC.

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Section: Introductionmentioning

confidence: 99%

The Causal Effects of Primary Biliary Cholangitis on Thyroid Dysfunction: A Two-Sample Mendelian Randomization Study

et al. 2021

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“…29 Concomitant autoimmune liver diseases, including autoimmune hepatitis and primary biliary cirrhosis, as causes of cholestasis have only been reported in a few case reports describing hyperthyroidism in patients. 7,8,39,40 This indicates that concomitant autoimmune liver diseases are not a common cause of cholestasis in these patients. However, other underlying liver diseases should also be excluded in patients with hyperthyroidism and cholestasis, especially in high epidemic countries of hepatitis B or C virus.…”

Section: Discussionmentioning

confidence: 95%

Challenges in early identification of causes and treatment of cholestasis in patients with hyperthyroidism: a case report and literature review

et al. 2019

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Early identification of the causes of cholestasis is important for appropriate management of patients with hyperthyroidism. We report a patient who had hyperthyroidism and severe cholestasis after methimazole (MMI) treatment. The patient was diagnosed as having MMI-induced cholestatic hepatitis. Treatment with MMI was stopped at admission to hospital. However, his serum total bilirubin (TBil) level rose from 410.5 µmol/L to 519.9 µmol/L and prothrombin time activity (PTA) dropped from 81.0% to 52.2% in 10 days. To prevent further deterioration of his liver function, plasma exchange was performed three times, and dexamethasone (10 mg, intravenously) was used each time. His PTA rose to 101% and his TBil continued to increase to 669.8 µmol/L after plasma exchange. He was subsequently diagnosed as having thyrotoxicosis-induced cholestasis and treated with radioactive iodine (380 MBq) 2 weeks after admission. His hyperthyroidism was significantly relieved, but the TBil level further increased to 776.8 µmol/L. Three weeks after admission, oral prednisone (30 mg/day) was used in this patient. Subsequently, his TBil levels gradually decreased and his liver function almost normalized within 3 months. We discuss the literature on cholestasis in the context of hyperthyroidism.

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“…It has been reported that the DRB1*08:03 allele and the DRB*08:03-DQB1:06:01 haplotype are associated with PBC in Japanese patients [ 26 ]. In addition, Suzuki et al reported a male case with DRB1*08:02 [ 16 ]. Although HLA typing could not be performed in the present case, a further study of genetic factors is needed in Japanese PBC patients with thyroid disease.…”

Section: Discussionmentioning

confidence: 99%

“…PBC has often been associated with many extrahepatic autoimmune diseases such as rheumatological disorders including Sjögren's syndrome and rheumatoid arthritis and endocrine diseases, either simultaneously or sequentially [5][6][7][8][9]. Among endocrine disorders, Hashimoto's disease with hypothyroidism has been commonly observed, but hyperthyroidism related to autoimmune thyroiditis (Graves' disease) has been very rare in cases with PBC [10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Over 3-Years Follow-Up of a Case of Primary Biliary Cholangitis With Autoimmune Hyperthyroidism: Factors Associated With Liver Dysfunction

Sato¹,

Kumagai²,

Suzuki³

et al. 2022

Cureus

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We present a rare case of a 50-year-old woman with simultaneous primary biliary cholangitis (PBC) and autoimmune hyperthyroidism in which the factors associated with liver dysfunction were evaluated over a 3year follow-up period. Although serum thyroid hormone levels improved after the administration of thiamazole, thyroid dysfunction was not directly associated with liver dysfunction. During the follow-up period, anti-hyperlipidemic drug therapy and eradication therapy for Helicobacter pylori (HP) infection caused transient elevation of serum transaminase levels. It should be recognized that serum liver enzyme levels might be affected by various factors, including the therapies for the many complications of PBC.

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Primary biliary cirrhosis associated with Graves’ disease in a male patient

Cited by 8 publications

References 21 publications

The Causal Effects of Primary Biliary Cholangitis on Thyroid Dysfunction: A Two-Sample Mendelian Randomization Study

The Causal Effects of Primary Biliary Cholangitis on Thyroid Dysfunction: A Two-Sample Mendelian Randomization Study

Challenges in early identification of causes and treatment of cholestasis in patients with hyperthyroidism: a case report and literature review

Over 3-Years Follow-Up of a Case of Primary Biliary Cholangitis With Autoimmune Hyperthyroidism: Factors Associated With Liver Dysfunction

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