一位64歲女性以急性黃疸表現之病例報告

A Case Report of a 64-Year-Old Female Presenting with Acute Jaundice

臨床上黃疸及肝功能異常可能原因相當廣泛，除了肝臟或膽道疾病外，也需要考慮感染、藥物、酒精甚至免疫疾病。本案例為一位亞臨床甲狀腺機能異常的64歲女性使用Polupi(丙硫氧嘧啶, Propylthiouracil, PTU)，於用藥後第二十六天出現肝功能上升及黃疸，經由病史收集、身體理學檢查、抽血檢驗，初步高度懷疑是藥物誘發肝損傷。影像檢查顯示膽管輕度擴張，因臨床症狀及肝功能改善不如預期，促使臨床團隊重新聚焦藥物使用史，並系統性排除感染、膽道阻塞、惡性腫瘤、病毒性、酒精性及免疫性肝炎等可能性。進一步輔以RUCAM（Roussel Uclaf Causality Assessment Method）及Naranjo不良藥物反應量表進行因果關係評估，結果支持PTU與肝損傷間具高度相關性，最終確認診斷為PTU誘發之藥物性肝損傷。立即停用PTU後，病人肝功能指數隨之逐步改善。本案例顯示，於抗甲狀腺藥物治療過程中，應密切監測肝功能變化，並於影像與臨床反應不一致時，及時回溯藥物史，結合量表評估工具以強化診斷判斷，儘早停藥以避免嚴重肝臟併發症之發生。

Jaundice and abnormal liver function can result from a wide range of causes, including liver and biliary tract diseases, infections, drugs, alcohol, and immune disorders. This case report describes a 64-year-old female with subclinical thyroid dysfunction, who developed elevated liver function and jaundice 26 days after receiving polupi (propylthiouracil, PTU). Drug-induced liver injury was suspected based on her medical history, physical examination, and blood tests. Imaging reveals mild biliary duct dilatation. Infections, biliary obstruction, malignancies, viral and alcoholic hepatitis, and immune diseases were ruled out through CT tomography and endoscopic retrograde cholangiopan¬creatography (ERCP). However, the clinical course and liver function improvement were not as ex-pected, prompting the clinical team to refocus on the medication history. Causality assessment using the RUCAM (Roussel Uclaf Causality Assessment Method) and the Naranjo Adverse Drug Reaction Probability Scale supported a strong association between PTU and liver injury. The final diagnosis was PTU-induced liver injury. Upon discontinuation of the medication, liver function improved with close monitoring. This case underscores the importance of regular liver function monitoring in pa¬tients on antithyroid drugs and highlights the need for vigilance regarding the potential complications of drug-induced liver injury. Early detection through comprehensive medication history and laboratory tests can prompt timly discontinuation of drugs and prevent severe complications.