title: Graves' disease presenting with severe cholestasis.
abstract: BACKGROUND
  Hyperthyroidism has been associated with liver function abnormalities; however, cholestasis as the presenting feature of adolescent Graves' disease has not been previously reported.
  
  
  RESULTS
  The patient was a 17-year-old girl who presented with severe cholestasis and was found to have Graves' disease. She also had a positive hepatitis A immunoglobulin M antibody but her clinical course, the liver histopathology, and her mildly elevated transaminases indicated that the acute hepatitis A infection was not dominant at the time of presentation with severe cholestasis. Other causes of cholestasis, including congestive heart failure, autoimmune hepatitis, and viral infection, were excluded. Treatment with methimazole resolved the hyperthyroidism, and the cholestasis improved, as well.
  
  
  CONCLUSIONS
  Severe cholestasis is a rare presenting feature of Graves' disease. With careful monitoring, methimazole can be used to treat the hyperthyroidism in the setting of cholestasis.
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Mount Sinai School of Medicine, New York, New York 10029, USA.
authors.forename: Molly O
authors.initials: MO
authors.lastname: Regelmann
authors.forename: Tamir
authors.initials: T
authors.lastname: Miloh
authors.forename: Ronen
authors.initials: R
authors.lastname: Arnon
authors.forename: Raffaella
authors.initials: R
authors.lastname: Morotti
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
authors.forename: Robert
authors.initials: R
authors.lastname: Rapaport
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000627:therapeutic use; D001663:Bilirubin / Q000032:analysis; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006506:Hepatitis A / Q000150:complications / Q000276:immunology; D035922:Hepatitis A Antibodies / Q000032:analysis; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D008111:Liver Function Tests; D008713:Methimazole / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D013960:Thyroid Function Tests
chemical_list: D000319:Adrenergic beta-Antagonists; D013956:Antithyroid Agents; D035922:Hepatitis A Antibodies; D007075:Immunoglobulin M; D008713:Methimazole; D011433:Propranolol; D001663:Bilirubin