Reviewer's report
Title:Acute-on-chronic liver failure due to methimazole in a patient with
hyperthyroidism and trilogy of Fallot: case report
Version: 1Date:11 July 2010
Reviewer: Raúl J J Andrade
Reviewer's report:
This manuscript describes a case report of fatal liver failure associated with
methimazole in a patient with pre-existing liver disease presumably related to
hyperthyroidism and/or Fallot trilogy. The case is interesting and the paper is
well-written, and nicely discussed with useful information.
Specific comments
The background’s abstract is incompletely ended (missing words).
In the introduction the terms toxic hepatitis and cholestatic jaundice are little
informative. What do they mean?
In case’s description the authors state that a lymphocyte stimulation test for
methimazole was positive. Please, provide more details on how the test was
performed. Also more detailed information on the final outcome leading to death
should be provided.
The authors discuss thoroughly the potential implication of thyroidal and cardiac
patient’s condition as causes of pre-existing liver disease. However, they do not
discuss the fact that chronic liver disease in this patient was unknown until the
acute episode.
The final statement on the need of physician awareness about the fact
“MMI-induced acute liver injury in the setting of chronic advanced fibrosis
increases the risk of poor outcome due to the impairment of hepatic
regeneration”, rather a particular recommendation, should actually be a general
attitude in this setting.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Acute-on-chronic liver failure due to methimazole in a patient with
hyperthyroidism and trilogy of Fallot: case report
Version: 1Date:11 July 2010
Reviewer: Raúl J J Andrade
Reviewer's report:
This manuscript describes a case report of fatal liver failure associated with
methimazole in a patient with pre-existing liver disease presumably related to
hyperthyroidism and/or Fallot trilogy. The case is interesting and the paper is
well-written, and nicely discussed with useful information.
Specific comments
The background’s abstract is incompletely ended (missing words).
In the introduction the terms toxic hepatitis and cholestatic jaundice are little
informative. What do they mean?
In case’s description the authors state that a lymphocyte stimulation test for
methimazole was positive. Please, provide more details on how the test was
performed. Also more detailed information on the final outcome leading to death
should be provided.
The authors discuss thoroughly the potential implication of thyroidal and cardiac
patient’s condition as causes of pre-existing liver disease. However, they do not
discuss the fact that chronic liver disease in this patient was unknown until the
acute episode.
The final statement on the need of physician awareness about the fact
“MMI-induced acute liver injury in the setting of chronic advanced fibrosis
increases the risk of poor outcome due to the impairment of hepatic
regeneration”, rather a particular recommendation, should actually be a general
attitude in this setting.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Acute-on-chronic liver failure due to methimazole in a patient with
hyperthyroidism and trilogy of Fallot: case report
Version: 1Date:11 July 2010
Reviewer: Raúl J J Andrade
Reviewer's report:
This manuscript describes a case report of fatal liver failure associated with
methimazole in a patient with pre-existing liver disease presumably related to
hyperthyroidism and/or Fallot trilogy. The case is interesting and the paper is
well-written, and nicely discussed with useful information.
Specific comments
The background’s abstract is incompletely ended (missing words).
In the introduction the terms toxic hepatitis and cholestatic jaundice are little
informative. What do they mean?
In case’s description the authors state that a lymphocyte stimulation test for
methimazole was positive. Please, provide more details on how the test was
performed. Also more detailed information on the final outcome leading to death
should be provided.
The authors discuss thoroughly the potential implication of thyroidal and cardiac
patient’s condition as causes of pre-existing liver disease. However, they do not
discuss the fact that chronic liver disease in this patient was unknown until the
acute episode.
The final statement on the need of physician awareness about the fact
“MMI-induced acute liver injury in the setting of chronic advanced fibrosis
increases the risk of poor outcome due to the impairment of hepatic
regeneration”, rather a particular recommendation, should actually be a general
attitude in this setting.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
assistant