{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:26:17Z","timestamp":1792805177046,"version":"4.5.0"},"reference-count":31,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T00:00:00Z","timestamp":1731974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health Research (NIHR)","award":["CS-2018-18-ST2-002"],"award-info":[{"award-number":["CS-2018-18-ST2-002"]}]},{"name":"NIHR\/Wellcome Trust Imperial Clinical Research Facility","award":["CS-2018-18-ST2-002"],"award-info":[{"award-number":["CS-2018-18-ST2-002"]}],"id":[{"id":"https:\/\/ror.org\/029chgv08","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NIHR Imperial Biomedical Research Centre","award":["CS-2018-18-ST2-002"],"award-info":[{"award-number":["CS-2018-18-ST2-002"]}],"id":[{"id":"https:\/\/ror.org\/01kmhx639","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Medical Research Council (MRC)","award":["CS-2018-18-ST2-002"],"award-info":[{"award-number":["CS-2018-18-ST2-002"]}]},{"name":"Biotechnology and Biological Sciences Research Council (BBSRC)","award":["CS-2018-18-ST2-002"],"award-info":[{"award-number":["CS-2018-18-ST2-002"]}],"id":[{"id":"https:\/\/ror.org\/00cwqg982","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NIHR Biomedical Research Centre Funding Scheme","award":["CS-2018-18-ST2-002"],"award-info":[{"award-number":["CS-2018-18-ST2-002"]}]},{"name":"NHS","award":["CS-2018-18-ST2-002"],"award-info":[{"award-number":["CS-2018-18-ST2-002"]}]},{"name":"NIHR Clinician Scientist Award","award":["CS-2018-18-ST2-002"],"award-info":[{"award-number":["CS-2018-18-ST2-002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Liver dysfunction can occur in patients presenting with thyrotoxicosis, due to several different aetiologies. A 42-year-old man had mild liver dysfunction on presentation with hyperthyroidism due to Graves\u2019 disease (GD): ALT 65 (0\u201345 IU\/L), fT4 41.2 (9\u201323 pmol\/L), fT3 &gt; 30.7 (2.4\u20136 pmol\/L), and TSH &lt; 0.01 (0.3\u20134.2 mIU\/L). His liver dysfunction worsened following the initiation of the antithyroid drug (ATD) carbimazole (CBZ), with ALT reaching a zenith of 263 IU\/L at 8 weeks following presentation. Consequently, CBZ was stopped, and he was managed with urgent radioiodine therapy. His liver function tests (LFTs) improved within 1 week of stopping carbimazole (ALT 74 IU\/L). Thionamide-induced liver dysfunction is more typically associated with a \u2018cholestatic\u2019 pattern, although he had a \u2018hepatitic\u2019 pattern of liver dysfunction. The risk of liver dysfunction in GD increases with older age and higher titres of thyroid-stimulating hormone receptor antibody (TRAb). This review of the literature seeks to explore the possible causes of liver dysfunction in a patient presenting with hyperthyroidism, including thyrotoxicosis-induced liver dysfunction, ATD-related liver dysfunction, and the exacerbation of underlying unrelated liver disease.<\/jats:p>","DOI":"10.3390\/jcm13226968","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T10:44:37Z","timestamp":1732013077000},"page":"6968","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Liver Dysfunction in a Patient with Graves\u2019 Disease"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5392-5161","authenticated-orcid":false,"given":"Filipa","family":"Campos","sequence":"first","affiliation":[{"name":"Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8180-6388","authenticated-orcid":false,"given":"Angelica","family":"Sharma","sequence":"additional","affiliation":[{"name":"Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1709-2410","authenticated-orcid":false,"given":"Bijal","family":"Patel","sequence":"additional","affiliation":[{"name":"Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK"},{"name":"Division of Endocrinology, Imperial College Healthcare NHS Trust, London W12 ONN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander N.","family":"Comninos","sequence":"additional","affiliation":[{"name":"Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK"},{"name":"Division of Endocrinology, Imperial College Healthcare NHS Trust, London W12 ONN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2795-5256","authenticated-orcid":false,"given":"Ali","family":"Abbara","sequence":"additional","affiliation":[{"name":"Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK"},{"name":"Division of Endocrinology, Imperial College Healthcare NHS Trust, London W12 ONN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,19]]},"reference":[{"key":"ref_1","first-page":"337","article-title":"Hepatic dysfunction in hyperthyroidism","volume":"7","author":"Khemichian","year":"2011","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1089\/thy.2020.0715","article-title":"Abnormal Liver Blood Tests in Patients with Hyperthyroidism: Systematic Review and Meta-Analysis","volume":"31","author":"Scappaticcio","year":"2021","journal-title":"Thyroid"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"117955142210746","DOI":"10.1177\/11795514221074672","article-title":"Hyperthyroidism and Liver Dysfunction: A Review of a Common Comorbidity","volume":"15","author":"Yorke","year":"2022","journal-title":"Clin. Med. Insights Endocrinol. Diabetes"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1093\/qjmed\/95.9.559","article-title":"The relationship between the thyroid gland and the liver","volume":"95","author":"Malik","year":"2002","journal-title":"QJM"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"768019","DOI":"10.1155\/2012\/768019","article-title":"Atypical Clinical Manifestations of Graves\u2019 Disease: An Analysis in Depth","volume":"2012","author":"Hegazi","year":"2012","journal-title":"J. Thyroid Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e6035","DOI":"10.1097\/MD.0000000000006035","article-title":"Risk factors of hepatic dysfunction in patients with Graves\u2019 hyperthyroidism and the efficacy of 131iodine treatment","volume":"96","author":"Wang","year":"2017","journal-title":"Medicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4636","DOI":"10.1111\/j.1582-4934.2008.00670.x","article-title":"Presence of thyrotropin receptor in hepatocytes: Not a case of illegitimate transcription","volume":"13","author":"Zhang","year":"2009","journal-title":"J. Cell. Mol. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e00086","DOI":"10.1002\/edm2.86","article-title":"Liver enzyme profile and progression in association with thyroid autoimmunity in Graves\u2019 disease","volume":"2","author":"Hsieh","year":"2019","journal-title":"Endocrinol. Diabetes Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1038\/s41574-019-0218-2","article-title":"Deiodinases and their intricate role in thyroid hormone homeostasis","volume":"15","author":"Luongo","year":"2019","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1210\/endrev\/bnz008","article-title":"Thyroid Hormone Transporters","volume":"41","author":"Groeneweg","year":"2020","journal-title":"Endocr. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"030006051989101","DOI":"10.1177\/0300060519891018","article-title":"Challenges in early identification of causes and treatment of cholestasis in patients with hyperthyroidism: A case report and literature review","volume":"48","author":"Zeng","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_12","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":"ref_13","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/0002-9343(89)90398-7","article-title":"Cholestatic jaundice in hyperthyroidism","volume":"86","author":"Yao","year":"1989","journal-title":"Am. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e244367","DOI":"10.1136\/bcr-2021-244367","article-title":"Graves\u2019 disease associated with cholestatic jaundice and persistent diarrhoea","volume":"14","author":"Rane","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_15","unstructured":"National Institute for Health and Care Excellence (2019). Thyroid Disease: Assessment and Management."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1056\/NEJMra042972","article-title":"Antithyroid Drugs","volume":"352","author":"Cooper","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1089\/thy.2019.0045","article-title":"Analysis of Antithyroid Drug-Induced Severe Liver Injury in 18,558 Newly Diagnosed Patients with Graves\u2019 Disease in Japan","volume":"29","author":"Suzuki","year":"2019","journal-title":"Thyroid"},{"key":"ref_18","first-page":"e15241","article-title":"Carbimazole-Induced Jaundice in Thyrotoxicosis: A Case Report","volume":"13","author":"Maliyakkal","year":"2021","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1111\/bcp.12336","article-title":"Antithyroid drug-related hepatotoxicity in hyperthyroidism patients: A population-based cohort study","volume":"78","author":"Wang","year":"2014","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1089\/thy.2014.0350","article-title":"Analysis of 90 Cases of Antithyroid Drug-Induced Severe Hepatotoxicity over 13 Years in China","volume":"25","author":"Yang","year":"2015","journal-title":"Thyroid"},{"key":"ref_21","first-page":"1","article-title":"An overview on the proposed mechanisms of antithyroid drugs-induced liver injury","volume":"5","author":"Heidari","year":"2015","journal-title":"Adv. Pharm. Bull."},{"key":"ref_22","unstructured":"National Institute of Diabetes and Digestive and Kidney Diseases (2012). LiverTox: Clinical and Research Information on Drug-Induced Liver Injury."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"164","DOI":"10.7326\/0003-4819-90-2-164","article-title":"Alkaline Phosphatase Isoenzyme Patterns in Hyperthyroidism","volume":"90","author":"Cooper","year":"1979","journal-title":"Ann. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/j.1572-0241.2001.03469.x","article-title":"The incidence and clinical characteristics of symptomatic propylthiouracil-induced hepatic injury in patients with hyperthyroidism: A single-center retrospective study","volume":"96","author":"Kim","year":"2001","journal-title":"Am. J. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1210\/jc.2009-0850","article-title":"Putting Propylthiouracil in Perspective","volume":"94","author":"Cooper","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/01.SMJ.0000054690.98272.B1","article-title":"Methimazole-induced Cholestatic Jaundice","volume":"97","author":"Mikhail","year":"2004","journal-title":"South. Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1089\/thy.2016.0229","article-title":"2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis","volume":"26","author":"Ross","year":"2016","journal-title":"Thyroid"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"910636","DOI":"10.1155\/2010\/910636","article-title":"Propylthiouracil-Induced Acute Liver Failure: Role of Liver Transplantation","volume":"2010","author":"Carrion","year":"2010","journal-title":"Int. J. Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3923\/jbs.2013.665.678","article-title":"Liver Functional Behavior During Thyrotoxicosis: A Review","volume":"13","author":"Mansourian","year":"2013","journal-title":"J. Biol. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"183.e1","DOI":"10.1016\/j.amjmed.2009.06.030","article-title":"Prevalence and Relative Risk of Other Autoimmune Diseases in Subjects with Autoimmune Thyroid Disease","volume":"123","author":"Boelaert","year":"2010","journal-title":"Am. J. Med."},{"key":"ref_31","first-page":"4157","article-title":"Persistent Increase in Bone Turnover in Graves\u2019 Patients with Subclinical Hyperthyroidism","volume":"85","author":"Kumeda","year":"2000","journal-title":"J. Clin. Endocrinol. Metab."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6968\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:35:18Z","timestamp":1760114118000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6968"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,19]]},"references-count":31,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13226968"],"URL":"https:\/\/doi.org\/10.3390\/jcm13226968","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,19]]}}}