{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T22:22:07Z","timestamp":1783376527262,"version":"3.54.6"},"reference-count":18,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,1,7]]},"abstract":"<jats:p>The effects of hypothyroidism on the liver are not well understood. A 77-year-old woman with Hashimoto\u2019s thyroiditis had stopped taking levothyroxine on her own for 6\u2009months. Her thyroid stimulating hormone (TSH) level was consistent with severe hypothyroidism. She resumed thyroid replacement therapy. The following month, her liver function tests were significantly elevated. Seven weeks after resumption of therapy, her TSH and liver tests had returned to normal. We attribute the mixed hepatocellular injury to hypothyroidism that resolved on correction of the hypothyroid state. This case reminds us that thyroid disease should be considered when evaluating acute liver injury.<\/jats:p>","DOI":"10.1136\/bcr-2017-222373","type":"journal-article","created":{"date-parts":[[2018,1,23]],"date-time":"2018-01-23T23:30:19Z","timestamp":1516750219000},"page":"bcr-2017-222373","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Case of acute mixed liver injury due to hypothyroidism"],"prefix":"10.1136","volume":"2018","author":[{"given":"Nikki","family":"Duong","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,1,23]]},"reference":[{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.1","doi-asserted-by":"crossref","first-page":"4591","DOI":"10.1210\/en.2014-1302","article-title":"Repair-related activation of hedgehog signaling in stromal cells promotes intrahepatic hypothyroidism","volume":"155","author":"Bohinc","year":"2014","journal-title":"Endocrinology"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/95.9.559"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.3","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/milmed\/143.8.548","article-title":"Abnormalities of liver function tests in tyrotoxicosis","volume":"143","author":"Thompson","year":"1978","journal-title":"Mil Med"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.4","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-199204000-00010"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.5","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1055\/s-2008-1041234","article-title":"The neuromuscular effects of hypothyroidism","volume":"11","author":"Laycock","year":"1991","journal-title":"Semin Neurol"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.6","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.76.897.424"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.7","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1984.00350130143025"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.8","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1007\/s12291-009-0067-1","article-title":"Biochemical markers of liver and kidney function are influenced by thyroid function-a case-controlled follow up study in Indian hypothyroid subjects","volume":"24","author":"Arora","year":"2009","journal-title":"Indian J Clin Biochem"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.9","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/j.1440-1746.1995.tb01106.x","article-title":"Clinical associations between thyroid and liver diseases","volume":"10","author":"Huang","year":"1995","journal-title":"J Gastroenterol Hepatol"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.10","first-page":"94","article-title":"Primary hypothyroidism","volume":"6","author":"Gaitan","year":"1997","journal-title":"Curr Ther Endocrinol Metab"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.11","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-77-6-927"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.12","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840090225"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.13","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/j.1365-2265.2007.03068.x","article-title":"Association between serum TSH, free T4 and serum liver enzyme activities in a large cohort of unselected outpatients","volume":"68","author":"Targher","year":"2008","journal-title":"Clin Endocrinol"},{"key":"2025082707491604000_2018.jan23_1.bcr-2017-222373.14","unstructured":"Becker KL . 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