Okay. I need to clear something up here. Contagious is off the table. During a broken-English exchange with Mexican Dude, someone asked him if he was contagious and he said yes, not knowing what the word meant. Please carry on with your diagnosis. Sorry for the confusion.
I love playing “House.”
I know! This is so fun and informative! I really wish there was a definitive way to know the true answer, like on Tuesday night TV, but with the language barrier, I think we’ll only be able to get “close” to a true diagnosis.
I’m just citing some statistics. The rate of infection transmission is low but not zero for monogamous partners where one person has hep C.
Meanwhile, it appears that for people who have sex with a lot of other people, their risk of getting hep c somewhere along the line is greater.
Ahh…okay. I feel less stupid now. Maybe I should start my own thread, and I apoligze for the hijack, but my mom’s doctor told her the following, as reported by my mom:
“The only way you can contract HPV is by having tons and tons of sexual partners.”
Err…no. The way you contract it (most likely anyway) is by having unprotected sex with ONE infected partner. The more partners, the more of a chance that one of them is “it.” The way I read your comments had me wondering for a few moments if my mom DIDN’T misunderstand her doc.
Also, I work at a company that is making a new drug application to the FDA next year for a Hep C treatment (I’m a science writer). So I thought I was a little better informed than your average bear about the virus. Glad to hear I’m not DUMB, I just can’t READ and interpret things.
The cite I gave is for a couple of cases of thyrotoxicosis presenting with clinical jaundice, so on a statistical basis there IS a way…just very low statistical probability. It was certainly news to me.
The “not very common” was referring to thyroid cancer as a cause of jaundice; not thyrotoxicosis. And I agree it would be highly unusual since the hepatobiliary region is not a target for thyroid ca mets. “Not very common” was a gentle way of communicating to a lay audince that it ain’t the cause, and I apologize for the choice of words. In medicine I’ve learned to try and stay away from “never.”
And Kalhoun: it’s not infectious hepatitis as a cause of thyroid problems. It’s that there is a very rare association of a super-overactive thyroid (thyrotoxicosis) presenting with jaundice (see the cite). In that case the thyroid problem would be the primary problem and the jaundice the secondary one. (And as KarlGauss points out, that would be unusual indeed) As with most mystery cases, you start looking for atypical presentations of rare conditions…
I’ll be sad now if he ends up being just a boring case. Unless he’s in the hands of twits, the longer the diagnostic dilemma goes on, the better his chances of making it to Grand Rounds. (Means he has an interesting diagnosis, or an interesting presentation of an ordinary diagnosis)
And your expertise. The student who suggests leukemia probably has that as her only differential diagnosis.
Nothing more painful for an attending than a student whose underecuted WAG ends up being correct by sheer luck.
Oh, I know!
I was a callow 3rd year student, having just had Internal medicine under my belt, then was doing OB. That night, I’d been up all night with deliveries, and in the AM rounds, we had a case of a baby spitting up blood.
When quizzed as to the potential causes, I automatically said: “esophageal varices”. And got roundly laughed at for thinking this newborn was equivalent to some chronic liver disease patient. And informed that the most likely diagnosis was the blood was from mom’s nipple or breast milk.
Well, that was the most likely cause. But it turned out the infant had congenital esophageal varices and was bleeding from them. I got my own laughs in at that point. (Baby did okay, fortunately).
Both Riedel’s thyroiditis and Hashimoto’s thyroiditis can be associated with liver findings. HT is reasonably often associated with autoimmune hepatitis. Or he could have MMU-induced liver failure from treating hyperthyroidism. More wild ass guesses.
This is totally irrelevant, but your post made me think of it.
In literally the first case of Graves he ever treated as an attending doc, my pal elected to use PTU. Of course, the patient developed fulminant hepatic necrosis (transaminases in thousands, high PT, etc) and came this close (") to getting a liver transplant. What a confidence builder 
There are other reasons for being told to stay home by your doctor than being contagious.
For people with Thyroid problems, one of the treatments involves radiation, after which it is usually advisable to avoid pregnant women and young children for a while.
Sometimes the doctor is just saying you need rest, and puts you back in the hospital, not because you’re a public health risk, but because you’re working yourself to death!
We may all be ignoring the obvious diagnosis:
This patient was involved in a drive-by shooting. A bullet passed through a hepatitis C-positive bystander and penetrated into our patient’s throat. It then traveled down the digestive tract and lodged in the small intestine in just such a way as to block the ampulla of Vater, thereby impeding bile drainage and causing jaundice. He’s contagious because he contracted Hep C from the contaminated bullet.*
As they say in the Guinness commercials: Brilliant!!!
*Of course this scenario is possible. Don’t forget that woman who was impregnated by a bullet passing through a Civil War soldier’s testicle. 
Any updates, Kalhoun?
you forgot to account for the weight loss 
Nope. Just a thyroid problem and 1-6 months off. Maybe someone can worm more info out of him when he returns from sick bay.
Yay for me on only the second try or so:
“Thyrotoxicosis (superactive thyroid going nuts) can present with jaundice:
http://www.endocrine-abstracts.org/.../ea0011p123.htm
That would make him a pretty cool case and also give him a good prognosis.”
I’m bettin’ that’s all it is, but thanks for posting it.
He’ll do fine and it will be closer to one month than six.