使用propylthiouracil的病人當中,高達三分之一的病人會發生無症狀的肝功能失調,嚴重的肝毒性卻是非常罕見。我們在此報告一個病例:一位四十七歲患有葛瑞夫茲症的女性,之前肝功能檢查爲正常,在服用五週的propylthiouracil之後,發生黃疸和食慾下降的現象。肝功能檢查顯示轉胺酶和總膽紅素數值升高。病患立即停用propylthiouracil並且肝功能逐漸恢復。經追蹤這名個案在肝炎發生三個月後仍平安無事。Propylthiouracil引發的肝毒性的診斷是藉由藥物開始使用與肝功能失調呈暫時性相關,並排除其他造成肝損傷的原因:例如病毒性肝炎、酒精性肝病、自體免疫性肝炎、遺傳疾患,以及其他肝毒性物質等。
Although asymptomatic liver dysfunction is observed in up to one-third of patients who received propylthiouracil, severe hepatotoxicity is rarely seen. Here we report a case of a 47-year-old female with Graves' disease previously having normal liver function tests. After 5 weeks of propylthiouracil administration, she developed jaundice and anorexia. Liver function tests showed elevated aminotransferase and total bilirubin level. Propylthiouracil was discontinued immediately and liver function improved gradually. The patient was uneventful three months after the flare of hepatitis. The diagnosis of propylthiouracil-induced toxic hepatitis was established by the temporal relation between the drug initiation and hepatic dysfunction, and exclusion of other causes of liver damage including viral hepatitis, alcoholic liver disease, autoimmune hepatitis, hereditary disorders, and other hepatotoxins.