Senior Resident, Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra, India, Corresponding Author.
Professor, Department of General Medicine, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India.
J Assoc Physicians India. 2024 Sep;72(9):22-25. doi: 10.59556/japi.72.0627.
Liver diseases are increasingly recognized as significant public health concerns in India, prompting investigations into novel approaches for assessing disease severity and prognosis. Recognizing the potential utility of thyroid hormone levels in these assessments, we conducted an observational cross-sectional study at our tertiary care hospital. Our study included 89 patients aged 12 years and above, admitted to medicine wards with ultrasound-diagnosed liver cirrhosis, excluding pregnant women and those on thyroid-altering medications.
Our findings revealed a male-to-female ratio of 4.23:1, with the majority of patients falling within the 40-60 age-group, averaging 46.93 years. Notably, 87.6% of patients exhibited thyroid abnormalities, primarily low free T3 (FT3) syndrome and subclinical hypothyroidism. Classifying patients according to Child-Pugh (CP) score, 2.2% were CP class A, 22.5% were CP class B, and the remaining 75.3% were CP class C. Across all CP classes, low FT3 syndrome was prevalent, particularly in CP class C. Correlations between thyroid hormone levels and liver disease severity, assessed CP and model for end-stage liver disease (MELD) scoring systems, were observed. Specifically, FT3 levels demonstrated a negative correlation with liver disease severity ( = 0.001), while no significant correlations were found for free T4 (FT4) and thyroid-stimulating hormone (TSH) levels. Based on our findings, we recommend routine thyroid function testing for all liver cirrhosis patients, irrespective of disease severity, to facilitate early detection and intervention. However, our study had limitations, including a small sample size and a precision error of 10% due to resource constraints for thyroid function testing. Moreover, reliance solely on ultrasound for liver cirrhosis diagnosis may lead to missed diagnoses, highlighting the need for complementary noninvasive tests such as FibroScan and aspartate aminotransferase to platelet ratio index (APRI) scores.
Our study underscores the importance of considering thyroid function in the management of liver cirrhosis patients and provides valuable insights for enhancing clinical practice in this context.
在印度，肝脏疾病日益被视为重大公共卫生问题，促使人们探索评估疾病严重程度和预后的新方法。鉴于甲状腺激素水平在这些评估中的潜在应用价值，我们在我们的三级保健医院进行了一项观察性横断面研究。我们的研究纳入了 89 名年龄在 12 岁及以上、因超声诊断为肝硬化而入住内科病房的患者，不包括孕妇和正在服用影响甲状腺功能药物的患者。
我们发现男女比例为 4.23:1，大多数患者年龄在 40-60 岁之间，平均年龄为 46.93 岁。值得注意的是，87.6%的患者存在甲状腺异常，主要为游离三碘甲状腺原氨酸（FT3）低下和亚临床甲状腺功能减退症。根据 Child-Pugh（CP）评分对患者进行分类，2.2%为 CP 分级 A，22.5%为 CP 分级 B，其余 75.3%为 CP 分级 C。在所有 CP 分级中，低 FT3 综合征均较为常见，尤其是 CP 分级 C 患者。观察到甲状腺激素水平与肝脏疾病严重程度之间的相关性，评估指标包括 CP 和终末期肝病模型（MELD）评分系统。具体而言，FT3 水平与肝脏疾病严重程度呈负相关（r=0.001），而游离甲状腺素（FT4）和促甲状腺激素（TSH）水平与肝脏疾病严重程度无显著相关性。基于我们的研究结果，我们建议对所有肝硬化患者进行常规甲状腺功能检测，无论疾病严重程度如何，以促进早期发现和干预。然而，我们的研究存在一些局限性，包括由于资源限制，甲状腺功能检测的样本量较小且存在 10%的精度误差。此外，仅依靠超声诊断肝硬化可能会导致漏诊，这凸显了需要使用 FibroScan 和天门冬氨酸氨基转移酶血小板比值指数（APRI）评分等补充性非侵入性检测手段的必要性。
我们的研究强调了在肝硬化患者管理中考虑甲状腺功能的重要性，并为这方面的临床实践提供了有价值的见解。
