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Table 1 Laboratory test results

From: Levothyroxine-induced liver injury followed by complete recovery upon cessation of the drug: a case report

Date* March March 12 March 14 March 15 March 23 March 26 March 27 March 31 April 4 April 5 April 9 April 15 April 18 April 20 April 24 May 1 May 16 September 12 Units
TSH     12.7 32.6     >75.0        34.8 21.06   0.27–4.20 IU/L
fT4                  10.58   pmol/L
T4          40.81        30.65    66–181
nmol/L
T3          0.72        2.9 2.52   1.2–3.1
nmol/L
D.Bil 2.4 1.4    1.26 1.1   0.7   0.5 0.5 1.4 0.4   0.4     <0.5 mg/dl
T.Bil      1.73 2.0   1.3   1.3 1.5   0.8 0.8 1.0    0.5 0.2–1.2 mg/dl
AST   372    26 195   74   49 45   33 25 31    15 5–34 U/L
ALT   549    69 486   191   101 86   56 35 41    18 0–55 U/L
AP   383    97 153   120   87 94   77   65     40–150 U/L
S.Alb   28     3.3         3.9     4.1 3.5–5.0 g/dl
HepBsAg   Negative                  
Anti-HCV   Negative                  
Anti-HAV IgG   Negative                  
Anti-HAV IgM   Negative                  
Anti-HEV IgM   Negative                  
Anti-CMV IgG   Positive                  
Anti-CMV IgM   Negative                  
Anti-LKM-1 Ab    1.8                 <10 U/ml
ASMA    1.9                 <15 IU/ml
ANA    0.3                 <1 IU/ml
Ceruloplasmin    45.94                 22–61 mg/dl
Hb        11.9             g/dl
WBC        8.2             ×109/L
Plt        267             ×109/L
  1. Abbreviations: ALT Alanine aminotransferase, ANA Antinuclear antibody, Anti HAV Anti-hepatitis A virus antibody, Anti HCV Anti-hepatitis C virus antibody, Anti HEV Anti-hepatitis E virus antibody, Anti-LKM − 1 Ab Liver kidney microsome type 1 antibody, AP Alkaline phosphatase, ASMA Anti-smooth muscle antibody, AST Aspartate aminotransferase, CMV Cytomegalovirus, D. Bil Serum direct bilirubin, fT4 Free thyroxine, Hb Hemoglobin, HepBsAg Hepatitis B surface antigen, Plt Platelets, S. Alb Serum albumin, T. Bil Total serum bilirubin, T3 Triiodothyronine, T4 Thyroxine, TSH Thyroid-stimulating hormone, WBC White blood cell count
  2. *Dates are all in 2018. Those in Italic font coincide with cessation of levothyroxine (second date was after the patient was rechallenged). Dates in Bold font coincided with commencement of T3 treatment
  3. The differential diagnoses were; viral Hepatitis, drug induced autoimmune hepatitis, drug induced hepatitis, non-alcoholic steatohepatitis (NASH) and sepsis with ‘bystander’ hepatitis