Bagas FAIRUSYAH, Amie VIDYANI
Perinatal Journal - 2026;34(2):133-142
Acute hepatitis B infection remains a clinical concern due to its potential progression to fulminant hepatitis and acute liver failure, particularly in patients with comorbid conditions requiring hepatotoxic medications. Graves' Disease, an autoimmune disorder characterized by hyperthyroidism, is commonly managed with antithyroid drugs such as propylthiouracil or methimazole, both of which carry a risk of liver injury. The coexistence of acute hepatitis B infection and Graves' Disease therefore presents a complex therapeutic challenge. We report a case of a 53-year-old woman presenting with acute hepatitis B infection in the setting of Graves' Disease and hypoparathyroidism. The patient presented with gastrointestinal symptoms and markedly elevated transaminase levels. Serological testing confirmed acute hepatitis B infection with positive HBsAg and IgM anti-HBc, while imaging and Fibroscan showed no evidence of chronic liver disease. Graves' Disease was confirmed by suppressed TSH, elevated free thyroxine, and high TRAb levels. The patient was managed conservatively with supportive therapy for acute hepatitis B without antiviral treatment, in accordance with international guidelines, while antithyroid therapy was modified from propylthiouracil to methimazole to minimize hepatotoxic risk. Clinical and laboratory improvement was observed, and follow-up demonstrated HBsAg clearance and anti-HBs seroconversion. This case highlights the importance of careful monitoring and individualized management strategies in patients with acute hepatitis B infection and concurrent Graves' Disease to prevent progression to severe liver injury while maintaining adequate control of thyroid function.
