Practice Lesson of the week

An unusual cause of jaundice

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39247.452141.BE (Published 11 October 2007) Cite this as: BMJ 2007;335:773
  1. P J D Owen, specialist registrar1,
  2. A Baghomian, consultant gastroenterologist2,
  3. J H Lazarus, consultant endocrinologist1,
  4. A J Godkin, consultant gastroenterologist and hepatologist3
  1. 1Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff
  2. 2Department of Gastroenterology, Glan Clwyd Hospital, Rhyl
  3. 3Department of Integrated Medicine, University Hospital of Wales, Cardiff
  1. Correspondence to
    : P J D Owen pennyowen74{at}yahoo.co.uk
  • Accepted 5 April 2007

Patients with jaundice of unknown cause need their thyroid function tested to exclude an underlying thyroid problem

We report on a patient with Graves' thyrotoxicosis, whose presentation with jaundice and hepatic dysfunction led to unnecessary investigations and a delay in management. We suggest patients with jaundice of unknown cause should have thyroid function tests performed as a part of their routine investigation.

Case report

A 36 year old labourer was referred to the gastroenterology department at his local hospital with a three month history of general malaise, myalgia, and painless jaundice. He reported a 25 kg weight loss and a change of bowel habit with pale diarrhoea and steatorrhoea, passing stools up to 20 times daily, with some darkening of his urine.

He had no medical history of note, was a non-smoker, consumed around 5 units of alcohol a week, and lived with his wife and teenage daughter. He had not travelled abroad recently and had had no occupational exposure to hepatitis or hepatotoxic chemicals or drugs. In addition, he had not received any blood products, undergone body piercings, or experienced any previous episodes of jaundice.

On clinical examination he was markedly cachetic and icteric, with no signs of chronic liver disease or tattoos evident. He had no fever and a pulse rate of 78 beats/min, blood pressure of 134/78 mm Hg, respiratory rate of 14 breaths/min, and BMI of 23.9. We detected no lymphadenopathy or …

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