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Lee, Sung, Kim, Yi, Kim, Lee, and Park: A Case of Hashimoto's Thyroiditis Accompanied by Autoimmune Hepatitis Diagnosed with Liver Biopsy
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2009; 24(4): 287-292.

Published online: 31 December 2009

DOI: https://doi.org/10.3803/jkes.2009.24.4.287

A Case of Hashimoto's Thyroiditis Accompanied by Autoimmune Hepatitis Diagnosed with Liver Biopsy

Young Jun Lee, Ji Yoon Sung, Sei Hyun Kim, Hyon Seung Yi, Yun Soo Kim, Sihoon Lee, Ie Byung Park

Department of Internal Medicine, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea.

Received 7 August 2009       Accepted 14 October 2009

Copyright © 2009 Korean Endocrine Society

Abstract

Autoimmune thyroid diseases, including Hashimoto's thyroiditis (HT), are common organ-specific autoimmune disorders that often occur in conjunction with other autoimmune diseases. Autoimmune hepatitis (AIH) is a relatively rare disease of unknown etiology. In this condition, progressive destruction of the liver parenchyma occurs. Without proper treatment with immunosuppressive agents, such as prednisone and azathioprine, this condition leads to cirrhosis and liver failure. Timely detection and appropriate treatment of the AIH is prerequisite for the long-term survival of affected patients. We report here a case of HT accompanied by AIH confirmed by liver biopsy. On the basis of this case report, we suggest that, a sustained elevation of aminotransferases refractory to thyroid dysfunction correction should result in a liver biopsy to differentiate AIH from other forms of liver dysfunction or secondary to thyroid disorders. Treatment should commence promptly.

Keywords: autoimmune hepatitis, Hashimoto's thyroiditis, liver biopsy

Figures and Tables

Fig. 1
Ultrasonography of patient's thyroid gland. Irregular and hypoechoic lesions were compatible with Hashimoto's thyroiditis.
jkes-24-287-g001
Fig. 2
Ultrasonography of patient's liver. Increased echogenecity was indicative of diffuse liver parenchymal disease.
jkes-24-287-g002
Fig. 3
Pathologic findings of liver biopsy. A. Marked infiltrations of portal and periportal lymphocytes and macrophages were noted, which is a typical finding of chronic hepatic inflammation (×100). B. Periportal necrosis and portal fibrosis with plasma cell reaction were seen, which is compatible with autoimmune hepatitis (×400).
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Table 1
Simplified diagnostic criteria for autoimmune hepatitis
jkes-24-287-i001

*Addition of points achieved for all autoantibodies (maximum, 2 points). ANA, anti-nuclear antibody; SMA, smooth muscle antibody; LKM, anti liver-kidney microsomal antibody; SLA, soluble liver antigen; AIH, autoimmune hepatitis.

Table 2
Autoimmune diseases frequently associated with autoimmune thyroid disease
jkes-24-287-i002

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