GRAVES HYPERTHYROIDISM IN A PATIENT WITH PRIMARY SCLEROSING CHOLANGITIS - COINCIDENCE OR COMBINED PATHOGENESIS

Several autoimmune disorders have been associated with the diagnosis o f primary sclerosing cholangitis (PSC). We report on a 19-year-old mal e PSC patient with a history of ulcerative colitis who developed hyper thyroidism consistent with Graves' disease. In contrast to primary bil iary cirrhosis, hyperthyroidism appears to be very uncommon in PSC pat ients. Nevertheless, the rarity of Graves' disease in young males, the presence of a human leucocyte antigen (HLA) phenotype often encounter ed in both Graves' disease and PSC and the presence of several autoant ibodies suggest a common immunogenetic predisposition, rather than mer e coincidence, of both diseases in this patient. Since many patients w ith thyroid disease exhibit mild cholestatic liver function abnormalit ies but few of them undergo cholangiographic examination, PSC may be u nderdiagnosed. Physicians should therefore be aware of the potential a ssociation between thyroid disease and PSC. (C) 1998 Rapid Science Ltd .