Jaundice and thyrotoxicosis in the absence of congestive heart failure. A study of four cases

Jaundice occurring in patients with hyperthyroidism is usually found in association with severe thyrotoxicosis complicated by congestive heart failure. The present report describes the clinical and laboratory features of four patients with thyrotoxicosis and jaundice in whom the presence of congestive heart failure could not be demonstrated. In these cases the degree of hyperbilirubinemia did not appear to be related to the severity of the hyperthyroidism. Although the serum bilirubin levels returned to normal or near normal values when the patients became euthyroid, results of bilirubin tolerance tests remained abnormal. No evidence was obtained for the presence of hepatic or hematologic disease which could account for the hyperbilirubinemia. It is suggested that these patients may have had an acquired or congenital defect either in the transport of bilirubin from plasma to the liver cell or in the intracellular conjugation of bilirubin and that this defect was aggravated by the superimposed hyperthyroid state.