Beating the Odds: A Full-Term Delivery After Liver Transplantation of a Pregnant Hyperthyroid Patient at 19 Weeks' Gestation for Propylthiouracil-Induced Acute Liver Failure

Liver transplantation (LT) for acute liver failure is an uncommon occurrence in the setting of pregnancy given the risk of fetal demise, and rarely is it undertaken with a viable fetus. Maternal hyperthyroidism increases fetal risk in the setting of LT, particularly in the setting of thyrotoxicosis. We report the first case of propylthiouracil-induced acute liver failure in a hyperthyroid patient in her second trimester resulting in LT. The multidisciplinary management led to a favorable outcome for the patient and the subsequent delivery of a healthy infant at 38-weeks' gestation. •Drug-induced liver failure can be managed successfully during pregnancy.•Management of hyperthyroidism during liver transplantation can be bridged with MARS therapy using a multidisciplinary team and a step-wise approach in the right clinical setting.•Liver transplantation proved successful for a pregnant woman at 19 weeks' gestation who developed liver failure secondary to propylthiouracil-induced drug injury in the setting of hyperthyroidism.