Punekar P, Sharma Ashvanee Kumar, Jain A
Department of Medicine, NSCB MCH, Jabalpur, Madhya Pradesh, India.
Indian J Endocrinol Metab. 2018 Sep-Oct;22(5):645-650. doi: 10.4103/ijem.IJEM_25_18.
Liver plays an important role in the metabolism of thyroid hormones, as it is the most important organ in the peripheral conversion of tetraiodothyronine (T4) to triiodothyronine (T3) by Type 1 deiodinase.
This case-control study included 100 decompensated liver cirrhosis patients (71 males and 29 females) and 100 apparently healthy controls (71 male and 29 female). Serum FT3, FT4, and thyroid-stimulating hormone (TSH) levels were measured using electrochemiluminescence immunoassay and analyses between cases versus healthy controls (Group 1) and further analyses in subgroups, cirrhosis with hepatic encephalopathy (HE) cases ( = 38) versus cirrhosis without HE cases (Subgroup 1), cirrhosis survivors ( = 84) versus cirrhosis nonsurvivors (Subgroup 2), HE survivors ( = 23) versus HE nonsurvivors (Subgroup 3). Results were also analyzed for severity of liver disease according to Child-Turcotte-Pugh (CTP) (Class A, B, and C), model for end-stage liver disease (MELD) score, and HE grades.
Most common etiology was alcohol (46%) and presentation was gross ascites (74%). Cirrhosis patients had statistically significant lower level of FT3 ( < 0.0001) and FT4 ( < 0.0001) but had higher level of TSH ( < 0.0001) compared with the controls. Cirrhosis with HE ( = 38) had significantly lower lever of FT3 ( < 0.0001) compared with cirrhosis without HE ( = 62), whereas there was no statistically significant difference in FT4 ( < 0.09) and TSH ( < 0.60) levels. FT3 level significantly low in HE Grade 4 patients compared with HE Grade 1 patients ( = 0.0001). In all cirrhotic patients, FT3 and FT4 were negatively correlated, but TSH level was positively correlated with total leukocyte counts, serum total bilirubin, aspartate transaminase, alanine transaminase, globulin, prothrombin time (PT), blood urea, serum creatinine, CTP, and MELD score. Overall, the most common abnormality seen was low T3 (low FT3) syndrome 41% (41 out of 100) in cases, 50% (19 out of 38) in cirrhosis with HE, and 32% (5 out of 16) in Non-survivors cases.
The mean FT3 and FT4 levels were significantly decrease and mean TSH levels were significantly increase in liver cirrhosis patients compared to healthy controls. Level of FT3, FT4, and TSH also correlate with the severity of liver disease, level of FT3 can be used as prognostic marker for liver cirrhosis patients.
肝脏在甲状腺激素代谢中起重要作用，因为它是通过1型脱碘酶将四碘甲状腺原氨酸（T4）外周转化为三碘甲状腺原氨酸（T3）的最重要器官。
本病例对照研究纳入100例失代偿期肝硬化患者（男性71例，女性29例）和100例明显健康的对照者（男性71例，女性29例）。采用电化学发光免疫分析法测定血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）水平，并对病例组与健康对照组（第1组）进行分析，以及在亚组中进一步分析，即肝硬化合并肝性脑病（HE）病例（n = 38）与无HE的肝硬化病例（亚组1）、肝硬化存活者（n = 84）与肝硬化非存活者（亚组2）、HE存活者（n = 23）与HE非存活者（亚组3）。还根据Child-Turcotte-Pugh（CTP）（A、B和C级）、终末期肝病模型（MELD）评分和HE分级对肝病严重程度进行结果分析。
最常见的病因是酒精（46%），表现为大量腹水（占74%）。与对照组相比，肝硬化患者的FT3水平（P < 0.0001）和FT4水平（P < 0.0001）在统计学上显著降低，但TSH水平较高（P < 0.0001）。与无HE的肝硬化患者（n = 62）相比，合并HE的肝硬化患者（n = 38）的FT3水平显著降低（P < 0.0001），而FT4水平（P < 0.09）和TSH水平（P < 0.60）无统计学显著差异。与1级HE患者相比，4级HE患者的FT3水平显著降低（P = 0.0001）。在所有肝硬化患者中，FT3和FT4呈负相关，但TSH水平与白细胞总数、血清总胆红素、天冬氨酸转氨酶、丙氨酸转氨酶、球蛋白、凝血酶原时间（PT）、血尿素、血清肌酐、CTP和MELD评分呈正相关。总体而言，最常见的异常情况是低T3（低FT3）综合征，病例组为41%（100例中的41例），肝硬化合并HE患者中为50%（38例中的19例），非存活者病例中为32%（16例中的5例）。
与健康对照组相比，肝硬化患者的平均FT3和FT4水平显著降低，平均TSH水平显著升高。FT3、FT4和TSH水平也与肝病严重程度相关，FT3水平可作为肝硬化患者的预后标志物。
