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Severe cholestatic hyperbilirubinaemia secondary to thyrotoxicosis complicated with bile cast nephropathy treated with plasma exchange and haemodialysis
  1. Anthony J Ocon1,
  2. Matthew Rosenblum1,
  3. James Desemone2 and
  4. Richard Blinkhorn1
  1. 1 Internal Medicine, Albany Medical College, Albany, New York, USA
  2. 2 Internal Medicine, Division Endocrinology, Albany Medical College, Albany, New York, USA
  1. Correspondence to Dr Anthony J Ocon, ocona{at}


Thyrotoxicosis rarely presents as cholestatic hyperbilirubinaemia, and severe bilirubin elevation may lead to bile cast nephropathy. We present a case of a young woman with newly diagnosed Graves’ disease with thyrotoxicosis who developed severe hyperbilirubinaemia and bile cast nephropathy. Serial plasma exchange and temporary haemodialysis led to full renal recovery. After treatment of her thyrotoxicosis with antithyroid medication and radioactive iodine ablation, her bilirubin normalised.

  • thyroid disease
  • liver disease
  • acute renal failure

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  • Contributors All authors participated in the patient’s care. They equally participated in planning, conduct, reporting, conception and design, acquisition of data for the case, interpretation of data, writing, editing and reviewing of the manuscript; gave final approval of the manuscript and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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