Korean J Gastroenterol.  2013 Jul;62(1):59-63. 10.4166/kjg.2013.62.1.59.

A Case of Simultaneously Occurred Amiodarone-induced Hepatitis and Hypothyroidism

• Cho YS
• Han JH
• Chae HB
• Kim JS
• Kang KM
• Park SM
• Lim JC

• KMID: 1711281
• DOI: http://doi.org/10.4166/kjg.2013.62.1.59

Abstract

Amiodarone is a di-iodated benzofuran derivative that is commonly used to treat patients with various cardiac arrhythmias. It is associated with side effects that involve the liver, thyroid, and other organs. Approximately 1-3% of patients treated with amiodarone suffer from symptomatic liver disease. Thyroid dysfunction occurs in 10% of patients treated with amiodarone. A 65-year-old woman with coronary heart disease and atrial fibrillation was administered with amiodarone. She developed nausea, vomiting, dyspepsia, and sweating within 9 months of amiodarone administration (200 mg orally once a day). Results of the laboratory finding showed increased hepatic enzymes, and low thyroid hormone levels. A liver biopsy showed irregular arrangement of hepatocytes and diffuse micro- and macrovesicular fatty changes. Electron microscopy findings showed pleomorphic mitochondria with crystalloid inclusions and membrane-bound lysosomal structures. The liver and thyroid functions returned to normal, after the amiodarone was stopped. We describe an unusual case in which amiodarone induced hepatitis and hypothyroidism simultaneously. Physicians should take a close look to the adverse event when using amiodarone which can cause adverse effects in multiple organs.

Keyword

Amiodarone; Toxicities, drug; Hepatitis; Hypothyroidism

MeSH Terms

Aged
Amiodarone/*adverse effects/therapeutic use
Arrhythmias, Cardiac/drug therapy
Drug-Induced Liver Injury/*complications/pathology/*radiography
Female
Fibrosis/pathology
Humans
Hypothyroidism/*chemically induced/*complications
Microscopy, Electron
Mitochondria/drug effects/metabolism
Tomography, X-Ray Computed
Treatment Outcome
Amiodarone

Figure

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  Fig. 1. Pre-enhanced abdominal computed tomography findings. The scan showed diffuse high attenuation in the liver parenchyma.

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  Fig. 2. Light microscopic liver findings. Irregular arrangement of hepatocytes and micro- and macrovesicular fatty changes (H&E, ×100).

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  Fig. 3. Portal tract was expanded by portal fibrosis with focal periportal fibrosis (Masson's trichrome, ×200).

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  Fig. 4. Electron microscopic liver findings. Mitochondria had crystalloid inclusions (arrow) (uranyl acetate and lead citrate, ×12,000).

Reference

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