Intrahepatic cholestasis in subclinical and overt hyperthyroidism: two case reports

Area of Science:

• Endocrinology
• Hepatology
• Internal Medicine

Background:

• Non-specific liver function test abnormalities can occur in hyperthyroidism.
• Hyperthyroidism may lead to elevated hepatic enzymes and bilirubin, with jaundice being a rare manifestation.
• Anti-thyroid drugs can rarely cause toxic hepatitis or cholestatic jaundice.

Purpose of the Study:

• To present two distinct cases of cholestasis associated with hyperthyroidism.
• To underscore the importance of considering hyperthyroidism in patients with unexplained liver dysfunction.

Main Methods:

• Case report of two patients presenting with cholestasis.
• Detailed clinical presentation and diagnostic workup for each case.
• Assessment of response to treatment, including rifampicin in one case.

Main Results:

• Case 1: Severe cholestasis in overt hyperthyroidism without congestive heart failure.
• Case 2: Intrahepatic cholestasis in subclinical hyperthyroidism, improving with rifampicin.
• Both cases demonstrate a link between hyperthyroidism and cholestatic liver injury.

Conclusions:

• Hyperthyroidism should be considered in the differential diagnosis of non-specific liver dysfunction.
• Cholestasis can be a presenting feature of both overt and subclinical hyperthyroidism.
• Prompt recognition and management of hyperthyroidism may be crucial for liver recovery.