Clinico-pathological study on fulminant and acute hepatitis severe form in patients with hyperthyroidism

Three cases of fulminant hepatitis and one case of acute hepatitis severe form occurring in the course of hyperthyroidism were studied clinico-pathologically. Case 1 was so-called thyroid crisis, died in the acute course of encephalopathy. Cases 2 and 3 developed fulminant hepatitis in the course of control of hyperthyroidism with antithyroid preparations. Case 4 presented hyperthyroidism combined with acute hepatitis severe form and cardiac insufficiency. Pathological studies of the liver showed coagulation necrosis of central ones in case 1, submassive necrosis in cases 2 and 3 and focal necrosis with features of venous congestion in case 4. It seemed that, in addition to the direct action of thyroid hormone, other factors such as the decrease of resistance to hepatotoxic substances, change of drug metabolism and cardiac insufficiency due to hyperthyroidism may be involved in aggravation of hepatic disorder in these patients.