title: Increased serum reverse triiodothyronine levels at diagnosis of hepatocellular carcinoma in patients with compensated HCV-related liver cirrhosis.
abstract: OBJECTIVE
  The aim of this study was to investigate changes in thyroid hormone metabolism in relation to the development of hepatocellular carcinoma (HCC) in patients with HCV-related liver cirrhosis.
  
  
  METHODS
  The study group (Group A) comprised 31 patients (25 M, 6 F; median age 62.1 years, range 54.0-81.5 years) affected by HCV-related liver cirrhosis with superimposed HCC. Acute and chronic systemic disease, other than cirrhosis, inducing 'euthyroid sick syndrome' was excluded in all patients. Serum TSH, FT4, FT3, rT3, and thyroxine-binding globulin (TBG) levels were retrospectively evaluated in frozen aliquots drawn at the time of tumour diagnosis and every 6 months for 3-7 years before HCC diagnosis. The control group (Group B) comprised 29 patients affected by HCV-related liver cirrhosis without HCC, matched for sex, age and grade of liver dysfunction.
  
  
  RESULTS
  At the time of HCC diagnosis, all patients in Group A were euthyroid with serum TSH, FT4, FT3 and TBG values not significantly different from those of cirrhotic patients of Group B. However, at diagnosis Group A patients had serum rT3 values that were significantly higher than those in Group B (35.0 ng/dl, range 12.0-162.0 vs. 19.0 ng/dl, range 10.0-51.0; Group A vs. Group B; P < 0.001). Serum rT3 values above the normal range were found in 12 patients in Group A (38.7%) but in only one of the patients from Group B (3.4%) (chi2 10.2; P = 0.001). The serum rT3 levels were not significantly correlated to the Child grade of liver cirrhosis (rho 0.1; P = 0.5). The intrasubject analysis demonstrated that a significant increase in serum rT3 levels occurred at the time of HCC diagnosis but serum FT4, FT3 and TSH values did not change significantly. A receiver operating curve (ROC) demonstrated that a 6-monthly increase in serum rT3 levels of at least +22.5% identified patients with HCC with a diagnostic accuracy of 81.7%.
  
  
  CONCLUSIONS
  Our study has demonstrated that development of hepatocellular carcinoma is accompanied by a significant increase in serum rT3 levels in patients with low-grade HCV-related liver cirrhosis who had no other illness causing the 'euthyroid sick syndrome'.
authors.affiliation: Department of Clinical and Experimental Medicine F Magrassi and A Lanzara, Second University of Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sorvillo
authors.forename: Gherardo
authors.initials: G
authors.lastname: Mazziotti
authors.forename: Antonella
authors.initials: A
authors.lastname: Carbone
authors.forename: Filomena
authors.initials: F
authors.lastname: Morisco
authors.forename: Michele
authors.initials: M
authors.lastname: Cioffi
authors.forename: Mario
authors.initials: M
authors.lastname: Rotondi
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Stornaiuolo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Amato
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Gaeta
authors.forename: Nicola
authors.initials: N
authors.lastname: Caporaso
authors.forename: Carlo
authors.initials: C
authors.lastname: Carella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000150:complications; D016022:Case-Control Studies; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000097:blood / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000821:virology; D008113:Liver Neoplasms / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D014285:Triiodothyronine, Reverse / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; D014285:Triiodothyronine, Reverse