Hypothyroidism-Associated Cholestasis

To the Editor.— We describe herein a case of cholestasis probably caused by hypothyroidism. We are unaware of similar previous reports. Report of a Case.— A 54-year-old woman was admitted to the hospital because of eight months of lethargy, constipation, cold intolerance, weight gain, and slowing of intellectual and motor activity, plus jaundice for the last two months. She was previously healthy and had not received any medication. Physical examination disclosed a jaundiced and obese woman with dry hair that fell out easily, macroglossia, cool skin, generalized myxedema, and absent tendon reflexes. The thyroid was not palpable, and there was neither hepatosplenomegaly nor signs of hepatic failure. Laboratory studies disclosed the following values: total serum cholesterol, 335 mg/dL; triglycerides, 337 mg/dL; direct bilirubin, 5.25 mg/dL; indirect bilirubin, 0.75 mg/dL; SGOT, 72 units/dL (reference range, 8 to 40 units/dL); SGPT, 25 units/ dL (range, 5 to 35 units/dL); and alkaline phosphatase,