title: Subtle hyperthyroidism presenting as suspected hepatobiliary disease.
abstract: Three patients, each with a nonspecific clinical history and raised serum alkaline phosphatase levels, were referred for investigation of hepatobiliary disorders. Isoenzyme analysis showed both hepatic and bony isoenzymes to be elevated, and eventually hyperthyroidism was diagnosed in each patient. Hyperthyroidism can be difficult to recognize clinically, and isolated elevation of serum alkaline phosphatase levels may be a useful clue.
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D001660:Biliary Tract Diseases / Q000175:diagnosis*; D004796:Clinical Enzyme Tests; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis* / Q000201:enzymology; D007527:Isoenzymes / Q000032:analysis; D008107:Liver Diseases / Q000175:diagnosis* / Q000201:enzymology; D008297:Male; D008875:Middle Aged
chemical_list: D007527:Isoenzymes; D000469:Alkaline Phosphatase