Year: 2025
Type: article
Study design: Case Report
Abstract: Hepatic involvement, though often asymptomatic, is frequently observed in cases of hyperthyroidism.However, jaundice can occasionally present as an unusual mode of discovery for this condition.We report the case of a 53-year-old patient who sought medical attention at the internal medicine department of the AbassNdao Hospital Center in Dakar (Senegal) for an isolated, non-fluctuating jaundice, without associated pruritus, in a context of cachexia.Biological investigations revealed elevated serum levels of alanine aminotransferase (ALT: 58 IU/L, 1.4 times the normal), aspartate aminotransferase (AST: 98 IU/L, 2.6 times the normal), alkaline phosphatase (602 IU/L, 2.2 times the normal), gamma-glutamyl transferase (102 IU/L, 3 times the normal), and bilirubin (total: 203.3 mg/L, 20.3 times the normal; conjugated: 148.4 mg/L, 29.6 times the normal).Complementary biological and radiological examinations excluded various hypotheses: biliary tract obstruction, viral, toxic, or autoimmune hepatitis, primary biliary cholangitis, and primary or secondary hepatic neoplasia.Thoraco-abdominopelvic computed tomography (CT-TAP) revealed a heterogeneous, plunging goiter.Cervical ultrasound confirmed a diffuse, hypervascular, plunging goiter, suggestive of Graves' disease, along with colloid cysts on the left side.Hormonal analysis showed an elevated free T4 level (43 pmol/L, normal range: 10-25 pmol/L) and a suppressed TSH level (0.017 μIU/mL, normal range: 0.15-4.9μIU/mL).Anti-TSH receptor antibodies were positive (3.304IU/L, normal: <1.5 IU/L).These findings led to the diagnosis of hepatic involvement secondary to Graves' disease without palpable goiter or ocular manifestations.The patient's clinical and biological condition improved under treatment with Benzylthiouracil (Basdene: 250 mg/day).Thus, in cases of unexplained isolated jaundice, screening for clinical and biological signs of hyperthyroidism could uncover unexpected diagnoses.
Authors: Niang Mouhamed Almakhy, Lo B, Ndour MA, Dieng M, Kiambati JBD, Sow D, Diédhiou D, Boundia D, Diallo IM, Gadji FK, Sarr A, Ndour-Mbaye M
Institution: Cheikh Anta Diop University
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4409181290