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Tu F, Lin Y, Chen J, Zhou L, Lin L, Liu Q, Wu W. Case report and literature review: A thyroid storm patient with severe acute hepatic failure treated by therapeutic plasma exchange and a double plasma molecular absorption system. Heliyon 2024; 10:e28867. [PMID: 38601545 PMCID: PMC11004571 DOI: 10.1016/j.heliyon.2024.e28867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
Thyroid storm (TS) leading to acute liver failure is rare but fatal in clinical practice and hepatic failure can remarkably limit medication options for TS. We successfully cured a patient with TS complicated with acute hepatic failure using therapeutic plasma exchange (TPE) and a double plasma molecular absorption system (DPMAS) and summarized the case characteristics of 10 similar critical patients reported worldwide. We recommend that patients with TS complicated with liver failure disuse propylthiouracil or methimazole. TPE should be utilized to rapidly decrease thyroid hormone levels, and DPMAS should be considered for supportive treatment in the presence of hepatic encephalopathy or dramatic bilirubin elevations.
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Affiliation(s)
- Fuquan Tu
- Department of Emergency Medicine, Fujian Medical University Union Hospital, Fujian, China
- Intensive Care Unit, Fujian Medical University Union Hospital Qishan Campus, Fujian, China
| | - Yiqin Lin
- Intensive Care Unit, Fujian Medical University Union Hospital Qishan Campus, Fujian, China
| | - Junnian Chen
- Intensive Care Unit, Fujian Medical University Union Hospital Qishan Campus, Fujian, China
| | - Lili Zhou
- Intensive Care Unit, Fujian Medical University Union Hospital Qishan Campus, Fujian, China
| | - Liyong Lin
- Department of Emergency Medicine, Fujian Medical University Union Hospital, Fujian, China
| | - Qin Liu
- Department of Emergency Medicine, Fujian Medical University Union Hospital, Fujian, China
| | - Wenwei Wu
- Department of Emergency Medicine, Fujian Medical University Union Hospital, Fujian, China
- Intensive Care Unit, Fujian Medical University Union Hospital Qishan Campus, Fujian, China
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Xu R, Xu P, Wei H, Huang Y, Zhu X, Lin C, Yan Z, Xin L, Li L, Lv W, Zeng S, Tian G, Ma J, Cheng B, Lu H, Chen Y. Ticlopidine induces embryonic development toxicity and hepatotoxicity in zebrafish by upregulating the oxidative stress signaling pathway. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 262:115283. [PMID: 37531924 DOI: 10.1016/j.ecoenv.2023.115283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/26/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
Ticlopidine exerts its anti-platelet effects mainly by antagonizing platelet p2y12 receptors. Previously, a few studies have shown that ticlopidine can induce liver injury, but the exact mechanism of hepatotoxicity remains unclear. Oxidative stress, metabolic disorders, hepatocyte apoptosis, lipid peroxidation, and inflammatory responses can all lead to hepatic liver damage, which can cause hepatotoxicity. In this study, in order to deeply explore the potential molecular mechanisms of ticlopidine -induced hepatotoxicity, we used zebrafish as a model organism to comprehensively evaluate the hepatotoxicity of ticlopidine and its associated mechanism. Three days post-fertilization, zebrafish larvae were exposed to varying concentrations (1.5, 1.75 and 2 μg/mL) of ticlopidine for 72 h, in contrast, adult zebrafish were exposed exposure to 4 μg/mL of ticlopidine for 28 days. Ticlopidine-exposed zebrafish larvae showed changes in liver morphology, shortened body length, and delayed development of the swim bladder development. Liver tissues of ticlopidine-exposed zebrafish larvae and adults stained with Hematoxylin & Eosin revealed vacuolization and increased cellular interstitial spaces in liver tissues. Furthermore, using Oil Red O and periodic acid-Schiff staining methods and evaluating different metabolic enzymes of ticlopidine-exposed zebrafish larvae and adults suggested abnormal liver metabolism and liver injury in both ticlopidine-exposed zebrafish larvae and adults. Ticlopidine also significantly elevated inflammation and oxidative stress and reduced hepatocyte proliferation. During the rescue intervention using N-acetylcysteine, we observed significant improvement in ticlopidine-induced morphological changes in the liver, shortened body length, delayed swim bladder development, and proliferation of liver tissues showed significant improvement. In conclusion, ticlopidine might inhibit normal development and liver proliferation in zebrafish by upregulation of oxidative stress levels, thus leading to embryonic developmental toxicity and hepatotoxicity. In this study, we used zebrafish as a model organism to elucidate the developmental toxicity and hepatotoxicity induced by ticlopidine upregulation of oxidative stress signaling pathway in zebrafish, providing a theoretical basis for clinical application.
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Affiliation(s)
- Rong Xu
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Pengxiang Xu
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Haiyan Wei
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Yong Huang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330029, Jiangxi, PR China
| | - Xiaodan Zhu
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Chuanming Lin
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Zhimin Yan
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Liuyan Xin
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Lin Li
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Weiming Lv
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Shuqin Zeng
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000 Jiangxi, PR China
| | - Guiyou Tian
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000 Jiangxi, PR China
| | - Jinze Ma
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000 Jiangxi, PR China
| | - Bo Cheng
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000 Jiangxi, PR China
| | - Huiqiang Lu
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000 Jiangxi, PR China.
| | - Yijian Chen
- The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China; The Endemic Disease (Thalassemia) Clinical Research Center of Jiangxi Province, Ganzhou 341000, China.
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Sonsuz A, Bakkaloglu OK. Biomarkers in Liver Disease. Biomark Med 2022. [DOI: 10.2174/9789815040463122010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Symptoms and signs of liver diseases are highly variable depending on the
etiology, disease stage, and type of liver involvement. There are different types of liver
diseases; causes of liver diseases may be viral, toxic, metabolic, or autoimmune.
However, in some cases, liver disease can develop as a result of diseases of other
organs or systems. It is almost impossible to differentiate all of these solely on the basis
of clinical symptoms and findings. Furthermore, the early stages of liver disease may
be completely asymptomatic, or in some cases, the disease may progress with only
subtle and non-specific symptoms. Therefore, biomarkers have a critical role in
screening, diagnosis, staging, and evaluation of therapeutic response to treatment in
liver diseases.
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Affiliation(s)
- Abdullah Sonsuz
- Department of Internal Medicine-Gastroenterology, Cerrahpasa Medical Faculty, Istanbul
University – Cerrahpasa, Istanbul, Turkey
| | - Oguz Kagan Bakkaloglu
- Department of Internal Medicine-Gastroenterology, Cerrahpasa Medical Faculty, Istanbul
University – Cerrahpasa, Istanbul, Turkey
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Silva NDOE, Ronsoni MF, Colombo BDS, Corrêa CG, Hatanaka SA, Canalli MHBDS, Schiavon LDL, Narciso-Schiavon JL. Clinical and laboratory characteristics of patients with thyroid diseases with and without alanine aminotransferase levels above the upper tertile - Cross-sectional analytical study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 60:101-7. [PMID: 26331222 DOI: 10.1590/2359-3997000000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/06/2015] [Indexed: 11/22/2022]
Abstract
Objective Thyroid disease affects 6.6% of the general population. The liver is fundamental in metabolizing thyroid hormones, and hepatocytes are often affected in thyroid disease. We aimed to compare clinical and laboratory parameters among thyroid disease patients with alanine aminotransferase (ALT) levels above vs. below the upper tertile. Subjects and methods A retrospective cross-sectional analytical study was conducted in the endocrinology clinic at Polydoro Ernani de São Thiago University Hospital. Patients with thyroid disease between August 2012 and January 2014 were included in the study. Clinical and laboratory parameters were collected from medical records. Results One hundred patients were included, of which 14.0% were male, with a mean age of 49.1 ± 14.4 years. ALT levels ranged from 9 to 90 U/L, and the ALT upper tertile was defined as 0,64 times the upper normal limit (xUNL). Patients with ALT levels above the upper tertile exhibited a higher proportion of systemic arterial hypertension (SAH), a higher mean abdominal circumference and a higher frequency of elevated TSH levels than did patients with ALT levels below the upper tertile. In multivariate analysis, ALT ≥ 0.64 (xUNL) was independently associated with abdominal circumference (odds ratio [OR] = 0.087, 95% confidence interval [CI] 0012-0167, P = 0.022). ALT (xUNL) correlated positively with total cholesterol (r = 0.213, P = 0.042). Conclusions In patients with thyroid diseases, it was observed that those with ALT above the upper tertile are associated with abdominal circumference and ALT levels correlate with total cholesterol.
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Affiliation(s)
- Nathanael de Oliveira E Silva
- Divisão de Gastroenterologia, Departamento de Medicina Interna, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | | | | | - Simone Aiko Hatanaka
- Divisão de Gastroenterologia, Departamento de Medicina Interna, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | - Leonardo de Lucca Schiavon
- Divisão de Gastroenterologia, Departamento de Medicina Interna, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Janaína Luz Narciso-Schiavon
- Divisão de Gastroenterologia, Departamento de Medicina Interna, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Guo Q, Yang W, Xiao B, Zhang H, Lei X, Ou H, Qin R, Jin R. Study on early biomarkers of zebrafish liver injury induced by acetaminophen. TOXIN REV 2014. [DOI: 10.3109/15569543.2014.986282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hambleton C, Buell J, Saggi B, Balart L, Shores NJ, Kandil E. Thyroid Storm Complicated by Fulminant Hepatic Failure: Case Report and Literature Review. Ann Otol Rhinol Laryngol 2013; 122:679-82. [DOI: 10.1177/000348941312201103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Thyroid storm is a presentation of severe thyrotoxicosis that has a mortality rate of up to 20% to 30%. Fulminant hepatic failure (FHF) entails encephalopathy with severe coagulopathy in the setting of liver disease. It carries a high mortality rate, with an approximately 60% rate of overall survival for patients who undergo orthotopic liver transplantation (OLT). Fulminant hepatic failure is a rare but serious complication of thyroid storm. There have been only 6 previously reported cases of FHF with thyroid storm. Methods: We present a patient from our institution with thyroid storm and FHF. A literature review was performed to analyze the outcomes of the 6 additional cases of concomitant thyroid storm and FHF. Results: Our patient underwent thyroidectomy followed by OLT. Her serum levels of thyroid-stimulating hormone, triiodothyronine, thyroxine, and transaminase normalized, and she was ready for discharge within 10 days of surgery. She has survived without complication. There is a 40% mortality rate for the reported patients treated medically with these conditions. Of the 7 total cases of reported FHF and thyroid storm, 2 patients died. Only 2 of the 7 patients underwent thyroidectomy and OLT — Both at our institution. Both patients survived without complications. Conclusions: Thyroid storm and FHF each independently carry high mortality rates, and managing patients with both conditions simultaneously is an extraordinary challenge. These cases should compel clinicians to investigate liver function in hyperthyroid patients and to be wary of its rapid decline in patients who present in thyroid storm with symptoms of liver dysfunction. Patients with rapidly progressing thyroid storm and FHF should be considered for total thyroidectomy and OLT.
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Prima V, Cao M, Svetlov SI. ASS and SULT2A1 are Novel and Sensitive Biomarkers of Acute Hepatic Injury-A Comparative Study in Animal Models. ACTA ACUST UNITED AC 2013; 2. [PMID: 23724364 DOI: 10.4172/2167-0889.1000115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Liver and kidney damage associated with polytrauma, endotoxic shock/sepsis, and organ transplantation, are among the leading causes of the multiple organ failure. Development of novel sensitive biomarkers that detect early stages of liver and kidney injury is vital for the effective diagnostics and treatment of these life-threatening conditions. Previously, we identified several hepatic proteins, including Argininosuccinate Synthase (ASS) and sulfotransferases which were degraded in the liver and rapidly released into circulation during Ischemia/Reperfusion (I/R) injury. Here we compared sensitivity and specificity of the newly developed sandwich ELISA assays for ASS and the sulfotransferase isoform SULT2A1 with the standard clinical liver and kidney tests Alanine Aminotransferase (ALT) and Aspartate Transaminase (AST) in various pre-clinical models of acute injury. Our data suggest that ASS and SULT2A1 have superior characteristics for liver and kidney health assessment in endotoxemia, Ischemia/Reperfusion (I/R), chemical and drug-induced liver injury and may be of high potential value for clinical applications.
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Kandil E, Khalek MA, Thethi T, Abd Elmageed Z, Khan A, Jaffe BM. Thyroid storm in a patient with fulminant hepatic failure. Laryngoscope 2011; 121:164-6. [PMID: 21120833 DOI: 10.1002/lary.21183] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This manuscript describes a 28-year-old patient with a history of Graves' disease who was transferred to Tulane University Hospital with fulminant hepatic failure. He reported associated nausea, vomiting, anorexia, as well as jaundice and abdominal discomfort for a period of 3 weeks prior to his admission. His thyroid function tests on admission were TSH, 0.013 μU/mL; T3, 94.9 μU/mL; T4, 9.37 μU/mL; Free T4, >6 μU/mL. His liver function tests were characteristic of hepatic failure. The patient underwent an emergent liver transplant. His surgery was complicated by heart failure and acute respiratory distress syndrome. Given the patients clinical presentation and laboratory results, a diagnosis of thyroid storm was made and a decision was made to proceed with an emergent thyroidectomy. The posttransplant multiorgan dysfunction was rapidly reversed by prompt thyroidectomy and decisive management. The patient was discharged from the hospital with normal thyroid and liver function tests.
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Affiliation(s)
- Emad Kandil
- Department of Surgery, Section of Endocrinology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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Kuo CS, Ma WY, Lin YC, Lin HD. Hepatic failure resulting from thyroid storm with normal serum thyroxine and triiodothyronine concentrations. J Chin Med Assoc 2010; 73:44-6. [PMID: 20103491 DOI: 10.1016/s1726-4901(10)70021-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 63-year-old male presented with productive cough, fever, palpitation, shortness of breath, and mental confusion. Fulminant hepatic failure occurred with high aminotransferase and severe jaundice. Thyroid function tests showed thyroid-stimulating hormone level of 0.7 microU/mL (normal range, < 6.2 microU/mL), with normal serum thyroxine and triiodothyronine levels. He died on post-admission day 5. Autopsy revealed diffuse hyperplasia of the thyroid gland, centrilobular necrosis of the liver, and congestion of the gastrointestinal tract, spleen, and adrenal glands. These pathological findings were compatible with decompensated hyperthyroidism. Thyroid storm may present with normal serum triiodothyronine, thyroxine, and hepatic failure. Such presentation is rare.
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Affiliation(s)
- Chin-Sung Kuo
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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