Apathetic Graves' disease with severe hepatic and renal dysfunction induced by COVID-19 infection : Case report and literature review

Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc..

RATIONALE: A rare and intractable case of apathetic Graves' disease (GD) with severe liver and kidney damage induced by coronavirus disease 2019 (COVID-19) carries a certain risk of missing diagnosis and delayed treatment during the COVID-19 pandemic.

PATIENT CONCERN: A 60-year-old female patient developed anorexia, exhaustion, jaundice, nausea, and vomiting 10 days after COVID-19 infection. She was admitted to the Infectious Diseases Department because of recurring symptoms for more than a month.

DIAGNOSIS: Based on the patient's epidemiological history, clinical symptoms, and prior history, she was preliminarily diagnosed with GD induced by COVID-19 with severe hyperthyroid-related liver injury and chronic kidney disease stage 4. Drug-induced and radiation-induced liver injuries occurred sequentially throughout the therapy.

INTERVENTION: Methimazole (MMI) (10 mg/d) was administered for 1 week, and the patient's symptoms, thyroid function, and liver and kidney function improved. Nevertheless, the aforementioned symptoms and liver and kidney function deteriorated 20 days after increasing the MMI dose (20 mg/d). Therefore, in the presence of an artificial liver, hemodialysis, and other medical conditions, the treatment schedule was adjusted to individualized 131I anti-hyperthyroidism therapy.

OUTCOME: After 131I treatment, the patient's liver function returned to almost normal levels after a month, but worsened when the hepatoprotective drugs were stopped. Renal function did not deteriorate significantly and returned to baseline after 3 months. Thyroid function was restored to normal approximately 4 months later.

CONCLUSION: COVID-19 may induce GD. Multidisciplinary collaboration can be initiated as early as possible. Individualized 131I therapy or long-term low-dose MMI (10 mg/d) can be considered to manage hyperthyroidism in GD patients with liver and kidney dysfunction and to prolong liver protection therapy appropriately.

Medienart:

E-Artikel

Erscheinungsjahr:

2024

Erschienen:

2024

Enthalten in:

Zur Gesamtaufnahme - volume:103

Enthalten in:

Medicine - 103(2024), 11 vom: 15. März, Seite e37456

Sprache:

Englisch

Beteiligte Personen:

Deng, Liting [VerfasserIn]
Zhang, Yingtong [VerfasserIn]
Sun, Huilin [VerfasserIn]

Links:

Volltext

Themen:

554Z48XN5E
Antithyroid Agents
Case Reports
Iodine Radioisotopes
Iodine-131
Journal Article
Methimazole
Review

Anmerkungen:

Date Completed 18.03.2024

Date Revised 18.03.2024

published: Print

Citation Status MEDLINE

doi:

10.1097/MD.0000000000037456

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM369793994