Case reports
Primary hypothyroidism masquerading as hepatic encephalopathy:
case report and review of the literature
Nicole Thobea, Pamela Pilgera, Michael P Jonesb
a University of
Cincinnati, Cincinnati, Ohio, USA: Department of Internal Medicine, b Division of
Digestive Diseases
Correspondence to: Dr Michael P Jones, Northwestern University School of Medicine, 251 East Huron Street, Galter Pavilion 4-104, Chicago, IL 60611-2908, USA (e-mail: mpjones{at}nmh.org)
Submitted 30 July 1999;
Accepted 22 November 1999
A 74 year old woman with hepatitis C of long duration
was admitted to hospital in hyperammonaemic coma. Despite aggressive treatment of hepatic encephalopathy, there was no clinical improvement. As part of her evaluation for other causes of altered mental status, she was found to be profoundly hypothyroid. Treatment with thyroid replacement hormone was accompanied by prompt normalisation of her
mental status and hyperammonaemia. Hypothyroidism may exacerbate hyperammonaemia and portosystemic encephalopathy in patients with otherwise well compensated liver disease. Hyopthyroidism should be
considered in the differential diagnosis of encephalopathy in patients
with liver disease.
Keywords: hypothyroidism; cirrhosis; hyperammonaemia; coma
© 2000 by The Fellowship of Postgraduate Medicine
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