Thyrotoxicosis Associated with Cholestatic Jaundice Treated with Therapeutic Plasma Exchange-Case Report

Abstract

Thyroid disorders, especially thyrotoxicosis, are commonly associated with hepatic dysfunction, but cholestasis is rarely reported. Heart failure, infection, weight loss may play role in the pathogenesis of cholestasis. Cholestasis could be worsened by treatment of hyperthyroidism using Thiamazole, but cholestasis in undiagnosed thyrotoxicosis is uncommon. We present 23 year old female with jaundice, goiter, palpitation and confirmed thyrotoxicosis associated with hepatomegaly, hepatocelluar damage and cholestasis. Liver biopsy excluded the suspicion of autoimmune hepatitis. Therapeutic plasma exchange was performed 5 days after starting the treatment with thyroid supressive therapy, and hepatoprotective therapy due to progressive increase of serum levels of bilirubin (conjugated/direct) and liver enzymes. The patient treatment continued with low doses of thyroid suppressive therapy. Patient achieved euthyroid state after 2 months with normalization of the serum levels of liver enzymes and bilirubin. The final treatment option for our patient was surgical total thyroidectomy.