甲状腺功能亢进及抗甲状腺药物与肝损害

甲状腺功能亢进(甲亢)、抗甲状腺药物均可引起肝损害。甲亢引起肝损害比较常见,可分为肝酶的升高和黄疸,其对肝功能损害的原因是多方面的,与甲状腺激素的直接毒性作用、高代谢、心力衰竭及免疫等因素有关;治疗原则以控制甲亢为主,甲亢治愈后,肝功能大多数可恢复正常。抗甲状腺药物引起肝损害的诊断通常采用排除法,其发病机制目前主要认为与机体的异质性反应有关;亚临床肝损害时不需停用抗甲状腺药物,如果肝损害显著,立即停药是治疗的关键。

Hyperthyroidism, anti-thyroid drug and liver injury

Both hyperthyroidism and anti-thyroid drugs can induce liver injury. Liver injury caused by thyrotoxicosis is relatively common, and can be conveniently divided into hepatitic or cholestatic types. The causes of liver injury induced by hyperthyroidism are complicated,related with the direct toxic effects of thyroxine, hypermetabolic state of the body, congestive heart failure, and immunological factors,etc. The therapeutic principle is to relieve the hyperthyroidism. When hyperthyroidism is under control, the liver function would return to normal. The liver injuries induced by anti-thyroid drugs, as an idiosyncratic reaction to the drug, can be diagnosed by the method of exclusion. Anti-thyroid drug can still be used in patients with sub-clinical liver injury. However, the offending drug must be discontinued immediately if hepatitic injury is severe.