A 32-year-old with no pre-existing liver disease was diagnosed with Graves' disease at week 4 of pregnancy. Thyroid-stimulating hormone was undetectable with elevated free thyroxine levels and positive thyroid receptor antibodies. She was started on a reducing regime of propylthiouracil (PTU). At week 20 in pregnancy, she became jaundiced. Initial bloods revealed: bilirubin 91 μmol/l, alanine aminotransferase 1,796 IU/l, alkaline phosphatase 200 IU/l, international normalized ratio 1.2, and albumin 33 g/l. A presumptive diagnosis of PTU-induced hepatitis was made. PTU was immediately discontinued and best supportive care instigated. Serum markers for autoimmune and viral hepatitis were negative, abdomen ultrasound, ferritin and caeruloplasmin were normal. Although her alanine aminotransferase began to fall, her bilirubin continued to rise, peaking at 378. Two weeks after PTU cessation she became thyrotoxic and was started on a reducing regime of carbimazole. Her thyroid function stabilized and liver function tests continued to improve with carbimazole stopped at week 32. Growth scans remained normal with delivery of a healthy baby at 38 weeks. This report highlights that good outcomes can be achieved in PTU-induced hepatitis in pregnancy. Patients on PTU should be warned of the potential risk of hepatic failure and advised to seek medical advice immediately if they develop jaundice.
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机译：怀孕第4周时，一名32岁没有肝病的患者被诊断出患有Graves病。游离甲状腺素水平升高和甲状腺受体抗体阳性无法检测到促甲状腺激素。她开始使用丙基硫氧嘧啶（PTU）的还原方案。在怀孕的第20周，她患了黄疸病。最初的血液显示：胆红素为91μmol/ l，丙氨酸转氨酶为1,796 IU / l，碱性磷酸酶为200 IU / l，国际归一化比率为1.2，白蛋白为33 g / l。作出PTU诱发肝炎的推定诊断。 PTU立即停止使用，并倡导最佳支持治疗。自身免疫和病毒性肝炎的血清指标阴性，腹部超声，铁蛋白和铜蓝蛋白正常。尽管她的丙氨酸转氨酶开始下降，但她的胆红素仍继续上升，达到378的峰值。PTU停止后两周，她开始产生甲状腺毒性，并开始使用咔咪唑进行还原。卡米咪唑在第32周停止时，甲状腺功能稳定并且肝功能测试继续改善。在38周分娩的健康婴儿中，生长扫描保持正常。该报告强调，妊娠期PTU诱发的肝炎可以取得良好的预后。应警告使用PTU的患者注意肝功能衰竭的潜在风险，并建议如果发现黄疸，应立即就医。
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