Anwar, C Varghese (2010) A Study on the Spectrum of Thyroid Abnormalities in Liver Disease and Its correlation with Liver Function. Masters thesis, Madras Medical College, Chennai.
|
Text
200100110anwar_varghese.pdf Download (1MB) | Preview |
Abstract
INTRODUCTION: “The difficulty lies, not in the new ideas, but in escaping the old ones, which ramify, for those brought up as most of us have been, into every corner of our minds.” Keynes, John Maynard. In most chronic illness, defects arise in thyroid hormone metabolism, resulting in the sick euthyroid syndrome. This is characterized by a normal total T4, normal/high free T4, low total T3, low free T3 and an elevated rT3. These changes reflect a reduction in D1 activity, an increase in D3 and changes in the plasma concentration of thyroid-binding proteins and free fatty acids (which displace thyroid hormones from binding proteins) There are also non-thyroidal influences on the hypothalamic-pituitary-thyroid axis, e.g. cortisol inhibiting TSH secretion. It has been suggested that this syndrome may confer a survival advantage, which adapts an organism to chronic illness by reducing the basal metabolic rate within cells and thereby reducing caloric requirements. In the different types of liver disease, similar processes may occur to those seen in the sick euthyroid syndrome, but in addition a number of changes specific to the type or stage of liver disease is also found. Many studies have been carried out in liver disease patients assessing their thyroid status; mostly in European countries and Japan. Most of these studies are limited by the number of patients in which these studies have been conducted. This study tries to find out the relationship between thyroid function and liver disease in the context of a tertiary care hospital in India. This study focuses on patients with complications of liver disease who are sicker than the patients in other studies. AIMS AND OBJECTIVES: 1. To determine the spectrum of thyroid abnormalities in both chronic and acute liver disease patients admitted in medical wards in Government General Hospital. 2. To compare the thyroid hormone levels in the liver diseases- both acute and chronic patients to that of healthy controls. 3. To assess the correlation between thyroid function and the level of liver dysfunction. 4. To assess the utility of thyroid function tests as a biomarker to differentiate acute from chronic liver disease. MATERIALS AND METHODS: Settings: Institute of internal medicine, Madras Medical College and Government General Hospital Chennai - 600 003. Study duration: This study was conducted for a period of eighteen months from Jan 2008 to October 2009. Study Design: A cross sectional study to determine the spectrum of thyroid abnormalities in acute and chronic liver disease patients getting admitted to general medical wards during the study period. Inclusion criteria: 1. Patients admitted in medical wards in Government General Hospital with diagnosis of acute or chronic liver disease from January 2008 to October 2009 were selected for the study. The first 50 patients admitted during the period with diagnosis of chronic liver disease were studied under the chronic liver disease category. Similarly the first 10 patients with the diagnosis of acute liver disease were studied. 2. Age greater than 12 years. Exclusion criteria: 1. Age less than 12 years. 2. Patients refusing to undergo the study. Methods: A detailed clinical history was elicited from patients selected for the study. A comprehensive physical examination was carried out on them, followed by a thorough review of their hospital records. Data was collected regarding the duration of symptoms, clinical features of liver disease and features of thyroid disease. Patients were divided into acute or chronic liver disease based on history, physical examination, and imaging. Any patient with duration of illness more than 2 months was considered to have chronic liver disease. On imaging coarse echoes and features suggestive of cirrhosis was taken as markers of chronic liver disease. Ascites was graded into three categories; 0- no ascites, 1- easily controlled ascites, 2- difficult to control ascites. Hepatic encephalopathy was graded into 3 categories; 0-none, 1-minimal and 2-advanced. Complete thyroid profile (thyroid stimulating hormone [TSH], free thyroxine [FT4], total thyroxine [TT4], free triiodothyronine [FT3] and total triiodothyronine [T T3]) of patients selected for the study was carried out using chemilumiscent immunological method. Patients underwent complete liver function tests. This included total and direct bilirubin, enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [AP]), serum total protein and albumin and prothrombin time. Prothrombin time was estimated using method. All patients underwent an abdominal ultrasonogram to confirm the diagnosis and to look for ascites splenomegaly and features of portal hypertension. Child-Pugh score was calculated for patients with chronic liver disease as a measure of the severity of liver disease. Thirty age and sex matched healthy controls were selected from among the attendees of the patients. They were given a complete physical examination liver function test evaluation to exclude liver disease. A complete thyroid profile (TSH, FT4, TT4, FT3, and TT3) was carried out on them. STATISTICAL ANALYSIS: Data analysis was done with use of SPSS, version 10. Descriptive statistics were used to calculate the frequency, mean, median, and standard deviation. For all normally distributed variables, Student’s t test and ANOVA test were used to determine the significant mean difference in various groups. The correlation between the various thyroid function variables and liver function variables was assessed by Pierson’s method. The significance of the difference between the various coefficients of correlations was evaluated using z transformation test. CONCLUSIONS: 1. Males constitute the majority of liver disease patients in govt general hospital and this is more prominent in the chronic liver disease group. The chronic liver disease patients are sicker and have more complications than acute liver disease patients. 2. Gross thyroid abnormalities are uncommon in liver disease patients if clinical features of thyroid dysfunction are absent. In every patient with liver disease signs of thyroid dysfunction should be looked for. Patients with features of thyroid dysfunction should promptly undergo laboratory evaluation. There is not enough evidence to suggest routine screening for thyroid dysfunction in liver disease patients in the absence of symptoms. 3. Different thyroid function parameters differ significantly between chronic liver disease patients, acute liver disease patients and controls. This can be utilized in differentiating acute liver disease patients from chronic patients. For this total T4 seems to be the most promising followed by free T3 and total T3. 4. Thyroid indices may be useful in assessing the prognosis of patients with liver disease since they show significant correlation with established markers of liver disease prognosis. In this regard free T3 seems to be the most promising in chronic liver disease patients. In acute liver disease there is nothing much to choose between total T4 and free T3. 5. Further prospective studies are required for validating and assessing the role of thyroid function tests as markers of prognosis in liver disease. Studies need to be carried out in each of the etiologically different liver diseases for better defining the role of thyroid hormones in each situation.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Spectrum of Thyroid Abnormalities ; Liver Disease ; correlation with Liver Function. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 29 Mar 2018 01:35 |
| Last Modified: | 16 Mar 2024 13:50 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6717 |
Actions (login required)
 |
View Item |
