Liver changes in exophthalmic goitre

The liver in other (nondiabetic) endocrine disorders

The liver has a major role in the proper maintenance of intermediate metabolism and endocrine homeostasis. It contains enzymes that are essential for hormonal biotransformation and the regulation of numerous metabolic reactions, which control hormone metabolism. The liver also manufactures several proteins, which carry circulating hormones to their effector sites. The endocrine system exerts tight control of the metabolic reactions within the liver, which also can be disturbed by endocrine disorders. These types of interactions and the effects of the exogenous hormones and the drugs that are used as treatment for hormonal disorders are discussed.

Abnormal results of liver function tests in patients with Graves' disease

OBJECTIVE

To determine the frequency of liver dysfunction in patients with hyperthyroidism.

METHODS

We analyzed the clinical records of 30 consecutive patients with Graves' disease to identify the spectrum of abnormal results of liver function tests. The values for alkaline phosphatase (AP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma -glutamyltransferase (GGT), and total bilirubin were examined.

RESULTS

The frequencies of increased levels of AP, AST, ALT, GGT, and bilirubin in the current study group were similar to but somewhat lower than those reported in previous studies. Of the 30 study patients, 11 (37%) had at least one abnormal result of a liver function test. All 30 patients in the study had determinations of AP (not fractionated), of which 10 values (33%) were above normal (range, 124 to 283 U/L). Of the 30 patients who had determinations of AST, 5 (17%) had increased values that ranged from 36 to 71 U/L. Six of the 23 patients (26%) with determinations of ALT had increased values that ranged from 45 to 157 U/L. Of the 25 patients who had measurements of GGT, 6 had above normal results (range, 69 to 331 U/L). In addition, 2 of the 24 patients (8%) with determinations of total bilirubin had increased levels.

CONCLUSION

These findings indicate that abnormal results of liver function tests are common in patients with hyperthyroidism and make the diagnosis of concomitant, unrelated liver disease difficult until the euthyroid state has been established.

Relative importance of formiminoglutamic and urocanic acid excretion after a histidine load

A thin-layer chromatographic method for the simultaneous assessment of formimino-glutamic (Figlu) and urocanic acid excretion after loading with 15 g. histidine has been applied to 15 control subjects and to 49 selected patients. Upper limits of normal excretion were determined for urocanic acid and Figlu alone (15 mg. and 30 mg/8 hr. respectively), and for the combined metabolites (40 mg./8 hr.). Of the 49 patients studied, 27 excreted total metabolites above 40 mg./8 hr.; of these 19 would have been revealed by their abnormal excretion of Figlu and 22 by their abnormal excretion of urocanic acid. Of 74 tests in the 64 subjects, urocanic acid was present in all but 27% of the tests, and in 29.8% of the tests urocanic acid was in excess of the amount of Figlu excreted. In six normal and six abnormal tests urocanic acid was the sole metabolite present. These results re-emphasize the value of estimating both histidine metabolites in tests for folate deficiency in man, and underline the greater relative importance of urocanic acid.