Thyroid Storm in the Presence of Acute Liver Failure - A Management Dilemma

Introduction: Hyperthyroidism presenting in conjunction with liver impairment leads to diagnostic and therapeutic dilemmas. This case report explores the intricate management challenges presented by the co-occurrence of thyrotoxicosis and liver impairment
Case Description: A 58-year old gentleman presented with features of cardiac and liver failure compounded by palpitations, weight loss, and a goiter suggestive of hyperthyroidis. Clinical findings unveiled features of Graves’ disease, right heart failure, and acute liver failure. Laboratory results confirmed acute-on-chronic liver cell disease (CLCD) and portal hypertension, coupled with hyperthyroidism indicative of a thyroid storm. Management challenges arose in initiating antithyroid drugs due to escalating liver enzymes. Therapeutic interventions encompassed propranolol for rate control, hydrocortisone, cholestyramine, Li2CO3, and early total thyroidectomy.
Conclusion: This case highlights the multifaceted nature of thyroid-liver interactions, emphasizing the need for a tailored therapeutic approach in addressing both endocrine and hepatic complications. The complexities surrounding autoimmune liver diseases and the impact of antithyroid drugs on liver function are discussed. Through this exploration, valuable insights are provided into the nuanced management of this challenging clinical scenario.