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Anastasiou O, Sydor S, Sowa JP, Manka P, Katsounas A, Syn WK, Führer D, Gieseler RK, Bechmann LP, Gerken G, Moeller LC, Canbay A. Higher Thyroid-Stimulating Hormone, Triiodothyronine and Thyroxine Values Are Associated with Better Outcome in Acute Liver Failure. PLoS One 2015; 10:e0132189. [PMID: 26147961 PMCID: PMC4493082 DOI: 10.1371/journal.pone.0132189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/10/2015] [Indexed: 12/15/2022] Open
Abstract
Introduction Changes in thyroid hormone levels, mostly as non-thyroidal illness syndrome (NTIS), have been described in many diseases. However, the relationship between acute liver failure (ALF) and thyroid hormone levels has not yet been clarified. The present study evaluates potential correlations of select thyroid functional parameters with ALF. Methods 84 consecutively recruited ALF patients were grouped according to the outcome of ALF (spontaneous recovery: SR; transplantation or death: NSR). TSH, free thyroxine (fT4), free triiodothyronine (fT3), T4, and T3 were determined. Results More than 50% of patients with ALF presented with abnormal thyroid parameters. These patients had greater risk for an adverse outcome than euthyroid patients. SR patients had significantly higher TSH, T4, and T3 concentrations than NSR patients. Albumin concentrations were significantly higher in SR than in NSR. In vitro T3 treatment was not able to rescue primary human hepatocytes from acetaminophen induced changes in mRNA expression. Conclusions In patients with ALF, TSH and total thyroid hormone levels differed significantly between SR patients and NSR patients. This might be related to diminished liver-derived transport proteins, such as albumin, in more severe forms of ALF. Thyroid parameters may serve as additional indicators of ALF severity.
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Affiliation(s)
- Olympia Anastasiou
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
| | - Svenja Sydor
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
| | - Jan-Peter Sowa
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
| | - Paul Manka
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
- Regeneration and Repair Group, The Institute of Hepatology, London, WC1E 6HX, United Kingdom
| | - Antonios Katsounas
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
| | - Wing-Kin Syn
- Regeneration and Repair Group, The Institute of Hepatology, London, WC1E 6HX, United Kingdom
- Liver Unit, Barts Health NHS Trust, London, United Kingdom
| | - Dagmar Führer
- Department of Endocrinology and Metabolism, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
| | - Robert K. Gieseler
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
- Rodos BioTarget GmbH, Medical Park Hannover, 30625, Hannover, Germany
| | - Lars P. Bechmann
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
| | - Lars C. Moeller
- Department of Endocrinology and Metabolism, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
| | - Ali Canbay
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg, Essen, 45122, Essen, Germany
- * E-mail:
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Abstract
The liver has an important role in thyroid hormone metabolism and the level of thyroid hormones is also important to normal hepatic function and bilirubin metabolism. Besides the associations between thyroid and liver diseases of an autoimmune nature, such as that between primary biliary cirrhosis and hypothyroidism, thyroid diseases are frequently associated with liver injuries or biochemical test abnormalities. For example, thyroid diseases may be associated with elevation of alanine aminotransferase and alkaline phosphatase, which is mainly of bone origin, in hyperthyroidism and aspartate aminotransferase in hypothyroidism. Liver diseases are also frequently associated with thyroid test abnormalities or dysfunctions, particularly elevation of thyroxine-binding globulin and thyroxine. Hepatitis C virus infection has been connected with thyroid abnormalities. In addition, antithyroid drug therapy may result in hepatitis, cholestasis or transient subclinical hepatotoxicity, whereas interferon (IFN) therapy in liver diseases may also induce thyroid dysfunctions. These thyroid-liver associations may cause diagnostic confusions. Neglect of these facts may result in over of under diagnosis of associated liver or thyroid diseases and thereby cause errors in patient care. It is suggested to measure free thyroxine (FT4) and thyroid-stimulating hormone (TSH) which are usually normal in euthyroid patients with liver disease, to rule out or rule in coexistent thyroid dysfunctions, and consider the possibility of thyroid dysfunctions in any patients with unexplained liver biochemical test abnormalities. It is also advisable to monitor patients with autoimmune liver disease or those receiving IFN therapy for the development of thyroid dysfunctions, and patients receiving antithyroid therapy for the development of hepatic injuries.
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Affiliation(s)
- M J Huang
- Division of Endocrinology, Chang Gung Memorial Hospital, Taipei, Taiwan
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