Severe Hyperthyroidism With Transient Hepatocellular Injury and Gallstone-Related Pancreatitis in Graves' Disease: A Case Report.

Graves' disease is an autoimmune thyroid disorder that can present with multisystem involvement, including transient hepatocellular dysfunction. While mild liver enzyme elevation is common in thyrotoxicosis, severe hepatic impairment and associated complications remain rare. We report the case of a 29-year-old man with newly diagnosed Graves' disease who initially presented with marked weight loss, palpitations, and biochemical thyrotoxicosis. He subsequently developed acute right upper quadrant pain, with imaging features suggestive of gallstone-related acute pancreatitis and deranged liver function tests. The hepatic impairment was attributed to possible gallstone migration in the context of rapid weight loss from hyperthyroidism, rather than thionamide-induced hepatotoxicity. This case highlights the complex interplay between hyperthyroidism and transient hepatocellular injury. It emphasizes the importance of considering thyroid dysfunction in the differential diagnosis of unexplained hepatic abnormalities, as well as the need for careful monitoring when initiating antithyroid therapy in patients with baseline liver dysfunction. Furthermore, it demonstrates that rapid metabolic shifts in untreated hyperthyroidism may predispose patients to gallstone formation and subsequent pancreatitis.