To the Editor.—
Systemic manifestations of hepatoma include hypoglycemia, erythrocytosis, and hypercalcemia, among others.1 Mildly elevated levels of thyroxine-binding globulin (TBG) have been recognized in a minority of patients with hepatoma.2 The case described herein demonstrates that increased TBG activity in hepatoma may lead to extreme elevation of circulating thyroid hormone in a clinically euthyroid patient. Because fever, weight loss, hypercalcemia, and other manifestations of hyperthyroidism can be seen due to hepatoma, the finding of a markedly elevated serum thyroxine (T4) or triiodothyronine (T3) level must be interpreted carefully in patients with hepatoma.
Report of a Case.—
A 52-year-old woman consulted her physician because of anorexia, weight loss, and an enlarging epigastric mass. She had not noted changes in hair, skin, or bowel habit. She had no past history of thyroid disease and serum T4 level was normal five years previously. She denied the use