Liver Injury Induced by Levothyroxine in a Patient with Primary Hypothyroidism

Tomotaka Kawakami; Atsushi Tanaka; Shinichiro Negoro; Yoshihiko Morisawa; Masaki Mikami; Makoto Hojo; Takatsugu Yamamoto; Satoko Uegaki; Mitsuhiko Aiso; Takahiro Kawasaki; Taro Ishii; Yasushi Kuyama; Toshio Fukusato; Hajime Takikawa

doi:10.2169/internalmedicine.46.0086

CASE REPORTS

Liver Injury Induced by Levothyroxine in a Patient with Primary Hypothyroidism

Tomotaka Kawakami, Atsushi Tanaka, Shinichiro Negoro, Yoshihiko Morisawa, Masaki Mikami, Makoto Hojo, Takatsugu Yamamoto, Satoko Uegaki, Mitsuhiko Aiso, Takahiro Kawasaki, Taro Ishii, Yasushi Kuyama, Toshio Fukusato, Hajime Takikawa

Author information

Tomotaka Kawakami
Department of Medicine, Teikyo University School of Medicine
Atsushi Tanaka
Department of Medicine, Teikyo University School of Medicine
Shinichiro Negoro
Department of Medicine, Teikyo University School of Medicine
Yoshihiko Morisawa
Department of Medicine, Teikyo University School of Medicine
Masaki Mikami
Department of Medicine, Teikyo University School of Medicine
Makoto Hojo
Department of Medicine, Teikyo University School of Medicine
Takatsugu Yamamoto
Department of Medicine, Teikyo University School of Medicine
Satoko Uegaki
Department of Medicine, Teikyo University School of Medicine
Mitsuhiko Aiso
Department of Medicine, Teikyo University School of Medicine
Takahiro Kawasaki
Department of Medicine, Teikyo University School of Medicine
Taro Ishii
Department of Medicine, Teikyo University School of Medicine
Yasushi Kuyama
Department of Medicine, Teikyo University School of Medicine
Toshio Fukusato
Department of Pathology, Teikyo University School of Medicine
Hajime Takikawa
Department of Medicine, Teikyo University School of Medicine

Keywords: levothyroxine, drug-induced liver injury

JOURNAL OPEN ACCESS

2007 Volume 46 Issue 14 Pages 1105-1108

DOI https://doi.org/10.2169/internalmedicine.46.0086

Details

Abstract

We report a patient with primary hypothyroidism, who developed hepatocellular injury due to levothyroxine, synthetic thyroxine. A 63-year-old male was admitted to our hospital due to elevation of liver enzymes. The patient was diagnosed as having hypothyroidism and had been treated with levothyroxine for almost two months until admission. Drug-induced liver injury induced due to levothyroxine was suspected and liver enzymes were rapidly decreased after discontinuation of levothyroxine and dried thyroid powder, also containing thyroxine. Synthetic triiodothyronine, the deiodinated form of levothyroxine was administered instead, and was well tolerated by the patient. The drug-induced lymphocyte stimulation test (DLST) using levothyroxine was negative. Since triiodothyronine which structurally resembles levothyroxine did not cause liver injury, and DLST using levothyroxine was negative, it is unlikely that levothyroxine itself was targeted by the immune system. Rather, we assume that the complex of levothyroxine as the hapten and liver-related macromolecules in the body as the carrier might have acquired antigenecity in this patient and subsequently resulted in liver injury.

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