Hyperthyroxinemia and elevated lipids as paraneoplastic phenomena in hepatocellular carcinoma. A case report

In the United States and Western Europe, primary hepato-cellular carcinoma is an uncommon malignancy. Even though many well-defined associations have been reported, paraneoplastic manifestations are rare in North American patients. We describe an adolescent with complaints of weight loss, weakness, and a sensation of ¿fullness in the upper abdomen.¿ On initial laboratory workup a lactescent serum was found, with the following abnormalities; serum cholesterol level of 573 mg/dl (normal 120-260), triglycerides of 1,761 mg/dl (normal 10-190), and serum thyroxine level of 21 microgram/dl (normal 5.5-12.3). Serum albumin, calcium, and thyroid-stimulating hormone levels were also minimally elevated. Liver biopsy confirmed hepatocellular carcinoma. This is a rare hepatoma, which in our case manifested with multiple paraneoplastic phenomena, including hyperthyroxinemia, hypercholesterolemia, hypertriglyceridemia, and hyperalbuminemia. We review the pertinent literature.