Acute Hepatitis-Like Syndrome Revealing Hashimoto Thyroiditis

Introduction: Disturbances of hepatic biologic tests are not uncommon during hypothyroidism but classically refer to rhabdomyolysis. More rarely, moderate and reversible chronic cholestasis or hypertransamenaemia can be observed. Acute hepatitis-like syndrome remains exceptional. Case report: 30-year-old patient with no pathological medical history was referred to us by her family doctor for suspicion of acute viral hepatitis: ASAT at 4N and ALAT at 3N, asthenia, abdominal pain, and vomiting evolving for three days in an epidemic context of hepatitis A. The clinical examination noted bradycardia at 58/min and macroglossia. Hepatic tests confirmed hepatocellular necrosis without cholestasis or hepatocellular insufficiency: ASAT at 355IU/l (8N), ALAT at 243IU/l (6N), total bilirubin at 14.80μmol/l, GGT at 15IU/l and PT at 100%. The serodiagnostics of viral hepatitis A, B and C, and specific liver autoantibodies were negative. Thyroid assessment revealed deep primary hypothyroidism with TSH at 182.7μmol/ml. The evolution under hormonal substitution treatment was favorable with disappearance of the clinical complaints and normalization of the liver tests with the normalization of the TSH. Conclusion: Acute hepatocellular necrosis remains an exceptional presentation of hypothyroidism. His diagnosis is not always easy, especially since in the autoimmune context of Hashimoto’s thyroiditis, the association with true autoimmune hepatitis can be discussed. As well as a thyroid disorder associated with chronic viral hepatitis. A screening of the thyroid function is thus justified in front of any hepatocellular necrosis that is not proven.