Thyroid storm-induced acute liver dysfunction and portal hypertension in a patient with Graves' disease: a case report

Figures & data

Table 1. Laboratory investigations of the patient.

Laboratory parameter	Value during hospitalization	Value after 3 months	Normal range
FT4 (pmol/l)	76	15.8	7–17
Hb (g/dl) WBC (E/mm^3) Plt (E/mm^3)	6.9 4100 67,000	12.2 5800 145,000	12–17 4000–9000 150,000–400,000
AST (UI/l) ALT (UI/l) T-Bili (μmol/l) D-Bili (μmol/l) ALP (UI/l) GGT (UI/l)	25 38 63 46 64 24	22 29 14 4 71 30	<40 <40 <17 <5 50–120 <40
PT (%)	53%	85%	70–100
Alb (g/l)	24	35	35–50
T-Ch (mmol/l)	1.41	4	3.5–5.2

Alb: Albuminemia; ALP: Alkaline Phosphatase; ALT: Alanine transaminase; AST: Aspartate transaminase; D-Bili: Direct bilirubin; FT4: Hb:Haemoglobin; GGT: Gamma-glutamyl transpeptidase; Plt: Platelets; PT: Prothrombin time; T-Bili: Total bilirubin; T-Ch: Total cholesterol; WBC: White blood cell count.

Table 2. The Burch-Wartofsky point scale of our patient^†.

Criteria	Points	Patient score
Thermoregulatory dysfunction (temperature °C) • 37.2–37.7 • 37.8–38.3 • 38.4–38.8 • 38.9–39.3 • 39.4–39.9 • ≥40.0	5 10 15 20 25 30	38.9 °C = 20
Cardiovascular Tachycardia (beats per min) • 90–109 • 110–119 • 120–129 • 130–139 • ≥140 Atrial fibrillation • Absent • Present	5 10 15 20 25 0 10	130 beats per min = 20
Congestive heart failure • Absent • Mild • Moderate • Severe	0 5 10 15	Absent = 0
Gastrointestinal-hepatic dysfunction • Absent • Moderate (diarrhea, abdominal pain, nausea/vomiting) • Severe (jaundice)	0 10 20	Jaundice = 20
Central nervous system disturbance • Absent • Mild (agitation) • Moderate (delirium, psychosis, lethargy) • Severe (seizure, come)	0 10 20 30	Agitation = 10
Precipitating event Status Absent Present	0 10	Treatment withdrawal = 10
Total score: ≥45 thyroid storm Impending storm Storm unlikely	25–44 <25	Thyroid storm = 80

† Data taken from [2].

Figure 1. Liver dysmorphia and signs of portal hypertension (splenomegaly [asterisk] and ascites [arrow]) on abdominal CT scan.

Burch HB, Wartofsky L. Life-threatening thyrotoxicosis, thyroid storm. Endocrinol. Metab. Clin. North Am. 22, 263–277 (1993).

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