Autoimmune cholangiopathy and high-output heart failure in a patient with graves disease.

Graves disease has a myriad of known symptoms, ranging from typical symptoms —such as anxiety, palpitations, diaphoresis, weight loss, heat intolerance, and muscle weakness—to less common symptoms such as high-output heart failure and cholestasis. A delay in the recognition of the underlying thyroid disease causing these symptoms can result in fatal consequences. We report a 36-year-old patient with Graves disease who had an atypical presentation of high-output heart failure and cholestasis secondary to autoimmune cholangiopathy (AIC); discussion of this case is followed by a review of AIC and autoimmune liver disease associated with Graves disease. To our knowledge, this case study is the first report of Graves disease associated with AIC.