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Cholestatic Hepatitis in Graves' Disease: A Diagnostic Challenge
Metri Haddaden1, Angy Hanna2, Fadi Odish2
1Department of Internal Medicine, MedStar Health, Baltimore, MD.
This study highlights cholestatic hepatitis as a rare initial symptom of Graves' disease, often mistaken for antithyroid drug side effects. Prompt diagnosis and treatment led to full recovery.
Area of Science:
- Hepatology
- Endocrinology
- Internal Medicine
Background:
- Cholestatic hepatitis is an uncommon manifestation of thyrotoxicosis.
- It can be misdiagnosed as an adverse reaction to antithyroid medications.
Observation:
- A 37-year-old man presented with cholestatic hepatitis as the first sign of Graves' disease.
- Laboratory tests revealed elevated liver enzymes, marked cholestasis, and suppressed thyroid hormones with positive thyroid-stimulating immunoglobulins.
- Imaging and liver biopsy confirmed cholestasis without fibrosis.
Findings:
- The patient's condition was diagnosed as Graves' disease based on hormonal profiles, positive thyroid antibodies, and radioiodine uptake scan.
- The R-factor value indicated significant cholestasis.
Implications:
- Recognizing cholestatic hepatitis as a potential presentation of thyrotoxicosis is crucial for accurate diagnosis.
- This case underscores the importance of considering endocrine disorders in unexplained liver dysfunction.
- Multifaceted treatment, including medication and surgery, resolved the condition.
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