{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:54Z","timestamp":1784557074639,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","issue":"3","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Thyroid storm represents a severe expression of thyrotoxicosis and is commonly associated by multiple organ dysfunction and liver abnormality. Thyrotoxicosis with concurrent autoimmune hepatitis is rare but could confound liver dysfunction, hence complicating diagnosis and subsequent management. We present the case of a 37-year-old woman with thyroid storm complicated by multiple organ failure and resistant hyperthyroidism. Despite initial medical therapy, her condition deteriorated with rising bilirubin and worsening right heart failure. Therapeutic plasma exchange (TPE) was initiated, leading to transient clinical and biochemical improvements. However, subsequent neurological decline and hepatic decompensation revealed an underlying autoimmune hepatitis, confirmed via biopsy at later stage. Intensive multimodal management, including further TPE sessions, ultimately stabilized her condition, allowing a safe and successful thyroidectomy. This report underscores the diagnostic challenge posed by overlapping autoimmune pathologies, the need for vigilant monitoring of thyroid and hepatic parameters, and the pivotal role of TPE as a rescue therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Dual autoimmune pathologies, such as autoimmune hepatitis and Graves\u2019 disease, can overlap and complicate diagnosis.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Persistent or worsening liver dysfunction despite improvement in other thyroid parameter may signal underlying liver pathology.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Importance of monitoring for rebound thyrotoxicosis and liver dysfunction in thyroid storm.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Therapeutic plasma exchange (TPE) as a critical rescue therapy in thyroid storm and metabolic or hepatic encephalopathy.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-25-0042","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T10:22:26Z","timestamp":1755685346000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Thyroid storm with concurrent autoimmune hepatitis: a case report on diagnostic challenges and the role of therapeutic plasma exchange"],"prefix":"10.1530","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3925-0798","authenticated-orcid":true,"given":"Mohd Hazriq","family":"Awang","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur \u2018Aini","family":"Eddy Warman","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatimah Zaherah","family":"Mohd Shah","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimi Fadilah","family":"Mohamad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur Aisyah","family":"Zainordin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohana","family":"Abdul Ghani","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"},{"name":"Institute of Pathology, Laboratory and Forensic Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Effat","family":"Omar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"},{"name":"Institute of Pathology, Laboratory and Forensic Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Thyroid","first-page":"1343","article-title":"2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis","volume":"26","author":"Ross DS","year":"2016","unstructured":"Ross DS\n, \nBurch HB\n, \nCooper DS\n, et al.\n 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. 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(https:\/\/doi.org\/10.1002\/jca.21832)"},{"key":"bib10","series-title":"J Hepatol","first-page":"69","article-title":"High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial","volume":"64","author":"Larsen FS","year":"2016","unstructured":"Larsen FS\n, \nSchmidt LE\n, \nBernsmeier C\n, et al.\n High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial. J Hepatol 2016 64 69\u201378. (https:\/\/doi.org\/10.1016\/j.jhep.2015.08.018)"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2025\/3\/EDM-25-0042.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2025\/3\/EDM-25-0042.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2025\/3\/EDM-25-0042.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:48:37Z","timestamp":1784555317000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3866"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":10,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.1530\/edm-25-0042","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]}}}