European Journal of Cardiovascular Medicine

Thyroid hormones regulate the basal metabolic rate of all cells including hepatocytes and thereby modulate hepatic function.⁽¹⁾Liver plays an important role in the metabolism of thyroid hormones, as it is the most important organ involved in the peripheral conversion of tetraiodothyronine(T4) to T3 by Type1deiodinase.⁽²⁾Moreover, the liver is involved in thyroid hormone conjugation and excretion, as well as the synthesis of thyroid binding globulin. Thyroid diseases may perturb liver function; liver disease modulates thyroid hormone metabolism and a variety of systemic diseases affect both the organs.(3)There are clinical and laboratory associations between thyroid and liver diseases. Changes in thyroid hormone levels are so well established that some workers have advocated its use as a reliable marker of liver function.⁽⁴⁾

Study design: The present study was a hospital based prospective case control observational study.

Place of study: This study was conducted at General Medicine Department ,King George Hospital,Visakhapatnam, Andhra Pradesh.

Duration of study: The study was conducted from November 2022 to July 2023.

Sample population: 80 subjects – 40 cases and 40 controls who were admitted in the medical wards of King George Hospital,Visakhapatnam.

Selection Criteria:

Inclusion criteria:

• Patients aged 25-75 years with symptoms, signs, biochemical and radiological evidence of chronic liver disease.
• Those patients willing to participate in the study.

Exclusion criteria:

• Patients with upper gastro intestinal bleeding.
• Patients with acute hepatic encephalopathy.
• Patients with renal failure.
• Patients already on thyroid medications.

METHODOLOGY :

The present study was undertaken after obtaining approval from Institutional Ethics Committee (IEC). Prior informed consent was taken from all the subjects enrolled in the study.Subjects who fulfilled selection criteria were taken as cases (study group).

Apparently healthy subjects (matched for age, sex) were included as a control group.

Complete history was taken and detailed physical examination was done.

Investigations including complete blood picture, renal function tests, liver function tests, thyroid profile (serum T3, T4, TSH, FT3, FT4), ultrasound abdomen and pelvis with portal vein doppler were done.Reports were obtained and then statistical analysis was carried out using unpaired t test. Results were expressed with respect to ‘p’ value, mean and standard deviation and were being interpreted.

Sex and age wise distribution of subjects :

INTERPRETATION :

• 42% patients with chronic liver disease showed significantly reduced levels of serum T3.
• 10% patients had low normal levels of FT3.
• 5% patients had low T4 values.
• All patients had normal FT4 and TSH values.
• Simple correlation analysis showed that serum T3 concentration significantly correlated with serum bilirubin, albumin and prothrombin in chronic liver disease but not with transaminases.

• Low T3 syndrome i.e., low total T3 with normal total T4 in the absence of clinical hypothyroidism has been frequently reported in patients with CLD and it has been shown to depend on impaired liver conversion of T4 to T3.
• The present study confirms a highly significant decrease in T3 serum concentration in liver disease; the lowest values correlate with severe disease and hence serum T3 concentration should be considered as a sensitive index of hepatic function in liver disease.
• Israel et al. reported significant correlation between serum T3 concentration and severity of liver dysfunction as well as progressive T3 increase in those subjects eventually displaying favourable outcome suggesting that T3 concentration in patients with advanced liver disease may be considered as helpful prognostic indicator.⁽⁵⁾
• Green et al. found normal FT3 and FT4 in a small group of cirrhotic patients while low FT4 and normal FT3 concentrations were present in alcoholic fatty liver patients.⁽⁶⁾
• Many studies performed on equilibrium dialysis, however showed decreased FT3 and normal or frequently increased FT4 concentration and these findings are confirmed by the present study.⁽⁷⁾
• These data suggest that in a patient with chronic liver disease, euthyroidism is maintained by a subtle equilibrium between low FT3 and increased FT4 concentrations. ⁽⁸⁾

The present study in which thyroid function has been evaluated with all the clinically available indices, confirms the existence of several abnormalities in thyroid function in chronic liver disease, although showing that euthyroidism is being maintained virtually in all patients, probably as a result of low normal FT3 and high normal FT4.Furthermore, serum T3 concentration appear to parallel the severity of liver dysfunction. So, thyroid function test should be done in all the patients of chronic liver disease to assess the severity of disease and for prognostication of patients.

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