Thyroid function tests in non-alcoholic cirrhotic patients with hepatic encephalopathy.

OBJECTIVES

Changes in thyroid hormone levels in non-alcoholic cirrhotic patients with hepatic encephalopathy were investigated in order to determine whether thyroid function tests could be a useful prognostic indicator for acute outcome.

METHODS

Patients with hepatic encephalopathy due to non-alcoholic cirrhosis were studied at Erciyes University Hospital, Kayseri, Turkey, between August 1990 and October 1991. Nine of them were males and eight females, with ages ranging between 22 and 69 years. Eleven cirrhotic patients who had no encephalopathy of any degree comprised the control group. Patients with hepatic encephalopathy were divided into two groups: survivors and non-survivors. The levels of serum triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), free T3 (FT3) and free T4 (FT4) were obtained in both patients with and without encephalopathy. Alterations of thyroid function tests and their relation to acute outcome were evaluated.

RESULTS

Serum T3 and FT3 levels were significantly lower in the patients who died of encephalopathy compared with controls (p < 0.05). Serum FT3 and FT4 were also lower in the survivors compared with those of the cirrhotic controls (p < 0.05). Albumin was found to be the unique and most important prognostic factor with a difference between survivors and cirrhotic controls (p < 0.05).

CONCLUSIONS

These data suggest that patients with liver disease due to non-alcoholic cirrhosis are under great risk for hepatic encephalopathy when they have low FT3 levels. The decrease of serum T3 and albumin levels could be considered as indicators of poor prognosis for acute outcome.