Huang M J, Liaw Y F
Division of Endocrinology, Chang Gung Memorial Hospital, Taipei, Taiwan.
J Gastroenterol Hepatol. 1995 May-Jun;10(3):344-50. doi: 10.1111/j.1440-1746.1995.tb01106.x.
The liver has an important role in thyroid hormone metabolism and the level of thyroid hormones is also important to normal hepatic function and bilirubin metabolism. Besides the associations between thyroid and liver diseases of an autoimmune nature, such as that between primary biliary cirrhosis and hypothyroidism, thyroid diseases are frequently associated with liver injuries or biochemical test abnormalities. For example, thyroid diseases may be associated with elevation of alanine aminotransferase and alkaline phosphatase, which is mainly of bone origin, in hyperthyroidism and aspartate aminotransferase in hypothyroidism. Liver diseases are also frequently associated with thyroid test abnormalities or dysfunctions, particularly elevation of thyroxine-binding globulin and thyroxine. Hepatitis C virus infection has been connected with thyroid abnormalities. In addition, antithyroid drug therapy may result in hepatitis, cholestasis or transient subclinical hepatotoxicity, whereas interferon (IFN) therapy in liver diseases may also induce thyroid dysfunctions. These thyroid-liver associations may cause diagnostic confusions. Neglect of these facts may result in over of under diagnosis of associated liver or thyroid diseases and thereby cause errors in patient care. It is suggested to measure free thyroxine (FT4) and thyroid-stimulating hormone (TSH) which are usually normal in euthyroid patients with liver disease, to rule out or rule in coexistent thyroid dysfunctions, and consider the possibility of thyroid dysfunctions in any patients with unexplained liver biochemical test abnormalities. It is also advisable to monitor patients with autoimmune liver disease or those receiving IFN therapy for the development of thyroid dysfunctions, and patients receiving antithyroid therapy for the development of hepatic injuries.
肝脏在甲状腺激素代谢中发挥着重要作用，甲状腺激素水平对正常肝功能和胆红素代谢也很重要。除了自身免疫性甲状腺疾病与肝脏疾病之间的关联，如原发性胆汁性肝硬化与甲状腺功能减退之间的关联外，甲状腺疾病还经常与肝损伤或生化检查异常相关。例如，甲状腺疾病可能与甲状腺功能亢进时丙氨酸氨基转移酶和主要来源于骨骼的碱性磷酸酶升高以及甲状腺功能减退时天冬氨酸氨基转移酶升高有关。肝脏疾病也经常与甲状腺检查异常或功能障碍相关，特别是甲状腺素结合球蛋白和甲状腺素升高。丙型肝炎病毒感染与甲状腺异常有关。此外，抗甲状腺药物治疗可能导致肝炎、胆汁淤积或短暂的亚临床肝毒性，而肝脏疾病的干扰素（IFN）治疗也可能诱发甲状腺功能障碍。这些甲状腺与肝脏之间的关联可能导致诊断混淆。忽视这些事实可能导致相关肝脏或甲状腺疾病的诊断过度或不足，从而在患者护理中造成失误。建议对肝病甲状腺功能正常的患者检测游离甲状腺素（FT4）和促甲状腺激素（TSH），以排除或确定是否并存甲状腺功能障碍，并在任何不明原因肝生化检查异常的患者中考虑甲状腺功能障碍的可能性。对于自身免疫性肝病患者或接受IFN治疗的患者，监测其甲状腺功能障碍的发生情况，对于接受抗甲状腺治疗的患者，监测其肝损伤情况，也是可取的。
