Cholestasis and protein-losing enteropathy secondary to hyperthyroidism in a 6-year-old girl

Abstract

Hepatic dysfunctions are not infrequent in patients with hyperthyroidism. These disorders may be related to the effects of the excess thyroid hormone secretion, to the uses of antithyroid drugs, or to the presence of concomitant hepatic diseases. Our aim is to describe the clinical and biochemical features of liver dysfunction related to thyrotoxicosis. We report here a case of a 6-year-old girl who was admitted for jaundice and pruritus as a result of the development of hyperthyroidism due to Graves' disease. On physical examination at admission, she was found to have jaundice and hepatomegaly. Laboratory data show cholestasis and protein-losing enteropathy. Investigations exclude other causes of hepatic disorder. One month after the initiation of antithyroid drug, the patient became euthyroid with improvement in jaundice and pruritus and normalization of hepatic tests and alpha antitrypsine clearance. In conclusion, the diagnosis of hyperthyroidism may be delayed in patients in whom the primary manifestations were pruritus and jaundice. The physician should suspect thyrotoxicosis prior to hepatitis or skin manifestations.

Severe hyperthyroidism without symptoms due to nonthyroidal illness in a child with acute hepatitis: case report and literature review

“…One is by Regelmann et al ., who described a 17‐year‐old female presenting with severe cholestasis in the setting of clinical and biochemical hyperthyroidism due to Graves’ disease; 57 although additional testing showed positive HAV IgM antibodies, suggestive of acute infection, the lack of significant transaminase elevation and liver biopsy findings suggested mild hepatocyte inflammation, and increased metabolic demand led the authors to conclude that cholestasis was the result of hyperthyroidism, rather than HAV‐related inflammation. The second report of a 6‐year‐old described presentation of cholestasis and thyrotoxicosis due to Graves’ disease, again without significant elevation in liver transaminase levels 58 …”