Hepato Thyroid Syndrome refers to a syndrome characterized by the simultaneous presence of chronic hepatitis and chronic thyroiditis, with a certain connection in their disease causes. It was first reported by MC Conkey et al. in 1960. This syndrome does not include liver damage caused by intrahepatic circulatory disorders or metabolic abnormalities due to thyroid diseases, nor does it include thyroid dysfunction caused by systemic malnutrition resulting from chronic liver disease.

bubble_chart Pathogenesis

The exact cause of the disease remains unclear. In recent years, there have been numerous reports of multiple endocrine autoimmune diseases, such as Schmidt syndrome, which involves simultaneous autoimmune diseases of the thyroid and adrenal glands. Therefore, it is speculated that this syndrome may also result from impaired immune function, leading to the production of autoantibodies (anti-thyroid and anti-liver antibodies) that trigger an immune response against the body's own tissues, causing simultaneous autoimmune diseases in both organs. The liver exhibits varying degrees of fibrosis and lymphocyte infiltration, while the thyroid shows diffuse or focal thyroiditis changes.

bubble_chart Clinical Manifestations

This condition is commonly seen in women over the age of 40, particularly those in menopause. Thyroid and liver diseases may occur sequentially or simultaneously. Diffuse thyroid enlargement with small nodules is often observed, usually without tenderness; liver disease manifests as hepatomegaly, splenomegaly, spider angiomas, and even ascites. In advanced stages, symptoms similar to portal hypertension may appear, but measurements of portal pressure reveal that splenomegaly is not due to portal hypertension but is related to autoimmunity and antibodies. 50% of patients may experience fever, polyarthritis, pleuritis, grade I rash, edema, Raynaud's phenomenon, and lymphadenopathy as autoimmune manifestations. Transient lupus-like or scleroderma-like symptoms may occasionally occur, sometimes accompanied by ulcerative colitis.

Laboratory tests showed an increased erythrocyte sedimentation rate, significantly elevated serum gamma globulin (mostly above 25g/L), and liver function tests revealed BSP retention, grade I elevated bilirubin, increased transaminase, grade I elevated alkaline phosphatase, and decreased cholesterol. Thyroid function was essentially normal, with positive urine protein, reduced PSP, grade I renal impairment, leukopenia, and grade I shortened red blood cell lifespan.

bubble_chart Diagnosis

Women over 40 years old with liver disease and goiter, and normal thyroid function can be diagnosed. Chronic hepatitis and portal cirrhosis should be excluded.

bubble_chart Treatment Measures

The primary treatment for intrinsic conditions mainly involves liver protection. Adrenal cortical hormones such as 6-MP can be administered to inhibit autoimmune reactions. In cases of cirrhosis and its complications, refer to the cirrhosis chapter; if hypothyroidism is present, thyroid hormone therapy may be provided.