HEPATIC GRANULOMATOSIS IN A PATIENT WITH GRAVES-DISEASE

We report a case of granulomatous hepatitis in a patient with hyperthy roidism resulting from Graves' disease. A 30-year-old man presented wi th massive weight loss, jaundice, tachyarrhythmia and goitre. Liver fu nction tests showed mild cytolysis and cholestasis and massive hyperbi lirubinaemia. The echogram of liver and bile ducts was normal and no i nfection was found. A liver biopsy revealed a mixed cytolytic and chol estatic hepatitis with intralobular epithelioid granulomas. No specifi c cause was identified, and sarcoidosis and primary biliary cirrhosis were ruled out. The outcome was favourable with antithyroid therapy an d short-term glucocorticoid therapy, and the patient was totally free of symptoms after 2 years. To our knowledge, this is the first case of granulomatous hepatitis to be reported in association with Graves' di sease. The clinical evolution of the liver disease paralleled the evol ution of hyperthyroidism.