Jaundice Revealing a Descending Goiter

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: 0.15-4.9 μIU/mL). Anti-TSH receptor antibodies were positive (3.304 IU/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.