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Severe cholestatic jaundice associated with Graves' disease
Abebe Abebe1, Leigh M Eck2, Michael Holyoak1
1Division of General and Geriatric Medicine, Department of Internal Medicine University of Kansas Medical Center Kansas City Kansas.
Clinical Case Reports
|November 21, 2018
Summary
This case study highlights a rare presentation of Graves' disease with atrial fibrillation and severe cholestasis. Treatment with methimazole and thyroidectomy proved effective, suggesting thionamides can be used cautiously in similar patients.
Area of Science:
- Endocrinology
- Hepatology
- Cardiology
Background:
- Graves' disease is an autoimmune disorder causing hyperthyroidism.
- Atrial fibrillation is a common cardiac complication of hyperthyroidism.
- Cholestasis, impaired bile flow, is an uncommon presentation of Graves' disease.
Observation:
- A patient presented with atrial fibrillation and severe cholestasis.
- Extensive hepatobiliary investigations, including liver biopsy, were negative for other causes.
- The patient's condition was linked to undiagnosed Graves' disease.
Findings:
- Successful management of cholestasis and atrial fibrillation was achieved through treatment of the underlying Graves' disease.
- Methimazole was used for initial management, followed by thyroidectomy.
- This indicates a direct link between Graves' disease and the observed cholestasis.
Implications:
- This case underscores the importance of considering endocrine disorders in unexplained cholestasis.
- Thionamide therapy, like methimazole, can be a viable treatment option for Graves' disease presenting with severe cholestasis, when used cautiously.
- Further research may elucidate the mechanisms linking Graves' disease to cholestasis.