When Thyroid Meets Dengue and Hepatitis: A Case of Severe Thyrotoxicosis with Multiorgan Dysfunction
https://doi.org/10.15605/jafes.041.S1
- Author:
Shamila Sutharsan
1
;
Yusniza Yusoff
1
Author Information
1. Hospital Sungai Buloh
- Publication Type:Journal Article
- MeSH:
Hepatitis A;
Thyrotoxicosis;
Dengue
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):112-113
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Severe thyrotoxicosis is an endocrine emergency that
may present with multiorgan dysfunction, particularly
when precipitated by systemic infection. Management
becomes challenging when hepatic injury limits the use of
standard antithyroid therapy. We report a case of severe
thyrotoxicosis with acute hepatitis in the setting of dengue
IgM positivity.
Case:A 44-year-old male with chronic alcohol use presented with
epistaxis. On examination, he was deeply jaundiced and
had tremors on outstretched hands. Initial investigations
showed severe hepatitis with AST 2029 U/L, ALT 698 U/L,
total bilirubin 236 µmol/L, alkaline phosphatase 138 U/L,
and thrombocytopenia (34 ×10⁹/L). Viral hepatitis HBV,
HCV, HIV, and autoimmune hepatitis screen were negative.
Dengue IgM was positive.
Thyroid function tests demonstrated overt thyrotoxicosis
with free thyroxine 4 (FT4) 58.6 pmol/L and suppressed
thyroid-stimulating hormone.
He was managed as severe thyrotoxicosis with impending
thyroid crisis in view of systemic illness and multiorgan
involvement. Due to significant hepatic dysfunction, he
was treated with propranolol, dexamethasone, and lithium
carbonate 300 mg BD. Over 5 days, there was marked
clinical improvement with resolution of tachycardia and
tremors. FT4 decreased to 44.8 pmol/L. Liver function
tests improved significantly (AST 157 U/L, ALT 195 U/L,
bilirubin 163 µmol/L), and thrombocytopenia resolved
(platelets 323 ×10⁹/L). He remained hemodynamically stable
with normal Glasgow Coma Scale throughout admission.
Conclusion:This case highlights severe thyrotoxicosis with acute
hepatitis and dengue infection, where management
was complicated by contraindication to conventional
antithyroid therapy. Lithium and corticosteroids provided
effective biochemical and clinical improvement. Early
recognition and individualized therapy are crucial in
complex multisystem thyrotoxic presentations.
- Full text:2026080508481885525EP_A167.pdf
