title: Liver cirrhosis and thyroid function: Friend or foe?
abstract: BACKGROUND
  The liver plays a central role in thyroid hormone metabolism, transport, and clearance. A normal function of both the thyroid gland and the liver is therefore necessary to maintain normal thyroid hormone levels and action. Data regarding thyroid function in patients with liver cirrhosis are scarce and variable. The most consistent finding is a decreased free triiodothyronine (fT3) level, which correlates with the severity of liver disease and has been proposed as a prognostic factor for liver-related complications.
  
  
  OBJECTIVE
  To evaluate thyroid hormone values in patients with stable liver cirrhosis and to compare them with healthy controls without liver disease. We also assessed the prevalence of thyroid autoimmunity and whether liver function tests correlated with thyroid function.
  
  
  METHODS
  We performed a prospective case-control study in an endocrinological setting. Twenty-nine patients with stable cirrhosis (20 males and 9 females, mean age 60.97 ± 7.17 years) were included in the case group and 50 healthy subjects (22 males and 28 females, mean age 61.70 ± 13.00 years) in the control group. We excluded patients with confounding factors known to influence thyroid function. Levels of serum thyroid-stimulating hormone (TSH), fT3, free thyroxine (fT4) and anti-TPO-antibodies (TPO-Ab) were measured. These thyroid hormone values were compared in both groups. Biochemical indices of liver function (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [AP], gamma-glutamyl transpeptidase [GGT], INR, total bilirubin, and albumin levels) were correlated with thyroid function tests.
  
  
  RESULTS
  fT3 en fT4 levels were significantly lower in patients with cirrhosis than in healthy subjects (p = 0.001 and 0.002, respectively). TSH levels were not statistically significantly different in the two groups. The level of TPO-Ab was not increased in patients with cirrhosis compared to healthy controls. fT3 correlated negatively with the Child-Pugh score.
  
  
  CONCLUSIONS
  These results indicate that, compared to healthy controls, patients with cirrhosis have decreased fT3 and fT4 levels and comparable TSH levels and may be consistent with findings of limited acquired central hypothyroidism as observed in the non-thyroidal illness syndrome (NTIS). fT3 levels correlated negatively with Child-Pugh score, a measure of severity of liver dysfunction. We did not find an increased prevalence of thyroid autoimmunity in these patients.
authors.affiliation: a Department of Internal Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Vincken
authors.affiliation: b Department of Gastro-Enterology , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Reynaert
authors.affiliation: c Laboratory of Hormonology and Tumor Markers , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Schiettecatte
authors.affiliation: d Department of Biomedical Statistics and Informatics , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium.
authors.forename: Leon
authors.initials: L
authors.lastname: Kaufman
authors.affiliation: e Department of Endocrinology , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Velkeniers
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D013960:Thyroid Function Tests; D013963:Thyroid Hormones / Q000097:blood*
chemical_list: D013963:Thyroid Hormones
keywords: Liver cirrhosis; Thyroid function tests