To the editor: We have read with interest the article by Cooper and co-authors in the February issue (1). In their discussion, the authors suggest that hyperthyroid patients with an elevated alkaline phosphatase and a normal 5′nucleotidase may be spared needless diagnostic evaluation when they present with these blood chemistry values. We have recently seen a patient with thyrotoxicosis; evaluation of her alkaline phosphatase elevation revealed hepatobiliary disease.
A 68-year old woman was admitted to hospital because of palpitations. Heat intolerance and an 11.3-kg weight loss had occurred over the past year. She denied abdominal pain or nausea but avoided