Levothyroxine sodium
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Liver injury: case report A 49-year-old woman developed liver injury during treatment with levothyroxine sodium for Hashimoto’s thyroiditis. The woman was diagnosed with Hashimoto’s thyroiditis. On 26 June 2017, she was started on oral replacement therapy with levothyroxine sodium [Euthyrox] 25 µg/day. On 3 July 2017, the dose of levothyroxine sodium was increased to 50 µg/day. At a regular follow-up on 4 August 2017, her AST and ALT were found to be elevated, indicative of liver dysfunction. She complained of fatigue and loss of appetite. Her lab tests showed elevated level of total bilirubin, in addition to the AST and ALT levels. The remaining examinations were insignificant. She did not have a recent history of trauma or blood transfusion, nor of any chronic diseases. The woman was hospitalised and her treatment with levothyroxine sodium was immediately discontinued. An abdominal ultrasonography revealed normal liver function. Subsequent examinations on the same day were still significant for elevated levels of AST and ALT. Therefore, she received treatment with IV glutathione [Atomolam] and sodium chloride, along with bicyclol tablet and silybin tablet. Eventually, her AST and ALT levels improved. On 18 September 2017, she was started on levothyroxine sodium [Letrox] 50 µg/day with hepato-protective drugs bicyclol tablets and silybin. The dose of levothyroxine sodium [Letrox] was increased to 50 µg/day. On 22 November 2017, her AST and ALT remained within normal range. Eventually, her hepato-protective drugs were discontinued. Her levothyroxine sodium [Letrox] was increased to 75 µg/day. No recurrence of liver dysfunction was noted. Author comment: "Recently we encountered a female hypothyroid patient with Hashimoto’s thyroiditis, who developed liver injury due to levothyroxine (Euthyrox)." "When the Roussel Uclaf Causality Assessment Method (RUCAM) scale was applied to our patient, the assessed score was consistent with probable drug-induced liver injury (DILI)." Yu H, et al. Liver dysfunction induced by levothyroxine sodium tablets (euthyrox) in a hypothyroid patient with hashimoto’s thyroiditis: Case report and literature review. Endocrine Journal 66: 769-775, No. 9, 2019. Available from: URL: http:// 803435015 doi.org/10.1507/endocrj.EJ19-0078 - China
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Reactions 23 Nov 2019 No. 1780
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