Background: Thyrotoxicosis is often associated with abnormal liver tests. This study aimed to characterize the clinical features and laboratory findings in thyrotoxic patients with liver abnormalities and to identify predictive factors for differentiating thyroid storm within this population. Methods: This is a retrospective review of thyrotoxic patients with hepatic dysfunction between January 2015, and January 2021, at Siriraj Hospital, Thailand. Univariate and multivariate analyses were performed to identify the factors associated with thyroid storm. Results: Among 771 thyrotoxic patients, 43 revealed abnormal liver tests within six months of diagnosis (5.58%). The mean age was 53.16 ± 15.10 years, with a female predominance (60.5%), and the majority (97.7%) were diagnosed with Graves’ disease. The most common comorbidities were atrial fibrillation, heart failure, and dyslipidemia. Hepatic dysfunction presented as non-specific, with 46.5% showing a cholestatic pattern, 30.2% a mixed pattern, and 20.9% a hepatocellular pattern. The most possible etiologies of hepatic dysfunction were hyperthyroidism-related hepatitis (41.9%) with atrial fibrillation with congestive hepatopathy (38.9%), concomitant with chronic hepatitis C infection (14.0%), and methimazole-induced hepatic dysfunction (9.3%). The younger age, congestive heart failure, and total bilirubin levels ≥ 3.0 mg/dL were independent factors in distinguishing clinical thyroid storm among thyrotoxic patients without thyroid storm. Conclusion: Liver abnormalities can be observed in patients with thyrotoxicosis. The possible causes are multifactorial, including hyperthyroidism-related hepatitis, atrial fibrillation with congestive hepatopathy, and chronic hepatitis C infection. Younger age, congestive heart failure, and total bilirubin ≥ 3.0 mg/dL were predictive factors for thyroid storm diagnosis among thyrotoxic patients.

Hepatitis A virus (HAV) and hepatitis E virus (HEV) infections often present as acute hepatitis with prodromal symptoms. These infections, transmitted via the oral–enteral route, constitute significant public health challenges, particularly in developing countries with subpar sanitary systems. The aim of the study was to describe the clinical manifestations, laboratory findings, and outcomes of hepatitis A and hepatitis E infections in Thailand. We conducted a retrospective chart review and analysis of 152 patients diagnosed with acute hepatitis A or hepatitis E from January 2007 to August 2018 at Siriraj Hospital. The hepatitis E cohort was older with a greater prevalence of comorbidities (hypertension, diabetes mellitus, chronic kidney disease, chronic hepatitis B, and post-kidney transplantation status) than the hepatitis A cohort. While the majority of hepatitis A patients presented with fever (98%) and jaundice (96%), these symptoms were less pronounced in hepatitis E patients. Furthermore, hepatitis A patients exhibited significantly higher aminotransferase and total bilirubin levels. However, clinical outcomes, such as hospitalization rates, progression to acute liver failure, and mortality, were comparable across both groups. In conclusion, although the clinical manifestations of hepatitis A and hepatitis E were similar, fever and jaundice were more prevalent and aminotransferase and bilirubin levels were higher in the HAV-infected group.

INTRODUCTION: Rapid urease test (RUT) is widely used for diagnosing Helicobacter pylori (HP) because it is inexpensive and practical. However, its accuracy is reduced in peptic ulcer bleeding (PUB). We prospectively performed a head-to-head comparison of diagnostic tests in the same patients to evaluate their performance in this setting. METHODS: After endoscopic hemostasis, gastric biopsies were obtained for RUT, histology, and polymerase chain reaction (PCR). Blood samples were collected for current infection marker and antiurease antibody. Urea breath testing (UBT) was performed in patients with negative RUT and histology. Diagnostic performance was assessed using a composite reference standard defined by at least 2 positive results among RUT, histology, PCR, and UBT. Logistic regression was used to identify factors associated with false-negative RUT. RESULTS: A total of 135 patients with PUB were enrolled, of whom 36 (26.7%) were HP-positive. Sensitivity/specificity was 69.4%/97.0% for RUT, 55.6%/96.0% for histology, 97.2%/92.9% for PCR, 77.8%/77.8% for current infection marker, and 83.3%/62.6% for antiurease antibody. Combining RUT, histology, and either PCR or UBT increased sensitivity to 100% and significantly outperformed RUT alone ( P = 0.021 and P = 0.001, respectively). PCR reduced idiopathic ulcers from 31.9% to 26.7%. Only 43 of 98 patients with negative RUT and histology underwent UBT because of clinical constraints, limiting its practicality despite excellent performance. No predictors of false-negative RUT were identified. DISCUSSION: In PUB, tissue PCR showed the best overall diagnostic performance among the single tests. RUT alone is insufficient for diagnosing HP, whereas combined testing with RUT, histology, and PCR or UBT achieved the highest diagnostic performance.