Overview
The syndrome of chronic hepatitis and chronic thyroiditis, which is etiologically related to each other, was first reported by MC Conkey et al. in 1960. The disease does not include hepatic damage caused by intrahepatic circulatory disorders or metabolic abnormalities due to thyroid disease and increased response to various etiologic stimuli; nor does it include systemic malnutrition caused by chronic liver disease that affects thyroid function.
Etiology
The etiology of this syndrome is unclear. It is hypothesized that the syndrome may be caused by a simultaneous autoimmune disease in both organs due to a disruption of immune function and the simultaneous production of autoantibodies (antithyroid and anti-hepatic) in response to an immune reaction against one’s own tissues. The liver disease has varying degrees of fibrosis and lymphocytic infiltration; the thyroid gland shows diffuse or focal thyroiditis changes.
Symptoms.
The disease is most common in women over 40 years of age, especially in menopausal women. Thyroid and liver disease may precede or follow, or occur simultaneously. Thyroid gland is diffusely enlarged with small nodules, mostly without pressure pain; liver disease shows hepatomegaly, splenomegaly, spider nevus, and even peritoneal effusion, and there are manifestations similar to portal hypertension in the late stage, but the splenomegaly is found to be related to autoimmunity and antibodies rather than due to portal hypertension after measuring portal pressure. 50% of the patients may have fever, multiple arthritis, pleurisy, mild rash, edema, Raynaud’s phenomenon and lymph node enlargement, and other autoimmune symptoms, including fever. and lymph node enlargement and other autoimmune manifestations. Sometimes there may be transient lupus erythematosus-like or scleroderma-like manifestations, or ulcerative colitis.
Examination
Laboratory tests include rapid blood sedimentation, markedly increased serum gamma globulin (mostly above 25g/L), liver function with retention of sodium phenol tetrabromophthalein (BSP), mild elevation of bilirubin, increased aminotransferase, mild elevation of alkaline phosphatase, and decreased cholesterol. Thyroid function is essentially normal, urine protein is positive, PSP is decreased, there is mild renal impairment, white blood cell count is decreased, and red blood cell life span is mildly shortened.
Diagnosis.
The diagnosis is made in women over 40 years of age with liver disease and goiter with normal thyroid function. Chronic hepatitis and portal cirrhosis should be excluded.
Differential diagnosis
This disease should be differentiated from diseases such as intrahepatic circulatory disorders or metabolic abnormalities caused by thyroid disease, liver damage caused by increased response to various etiologic stimuli, and systemic malnutrition caused by chronic liver disease that affects the function of the thyroid gland.
Complications
Patients are often complicated by polyarthritis, pleurisy, mild rash, edema, Raynaud’s phenomenon with ulcerative colitis.
Treatment
The main treatment is hepatoprotective. Adrenocorticotropic hormones or 6-mercaptopurine (6-MP) can be given to stop the autoimmune response. If there is cirrhosis and its comorbidities, refer to the treatment of cirrhosis; if there is hypothyroidism, administer thyroxine.
Prevention
The disease should be actively prevented from liver disease and thyroid disease. At the same time, physical exercise should be strengthened to improve autoimmunity.