THYROID DYSFUNCTION IN CHRONIC LIVER DISEASE AND ITS CORRELATION WITH SEVERITY OF LIVER DISEASE

ABSTRACT Objective: Chronic liver disease (CLD) may have thyroiditis, hyperthyroidism, or hypothyroidism. Liver plays an important role in the metabolism of thyroid hormones, as it is the most important organ in the peripheral conversion of tetraiodothyronine (T4) to T3 by Type 1 deiodinase. The aim was to evaluate the thyroid hormone level (TSH, fT4 and fT3) in the CLD patient and to find out correlation between thyroid hormone level and severity of CLD. Methods: This case-control study included 100 CLD (case) and 100 apparently healthy controls from wards and outpatient department of Department of Medicine with clinical, biochemical, and radiological evidence of CLD. Severity of CLD was accessed according to Child–Turcotte–Pugh (CTP), model for end-stage liver disease (MELD) score, and HE grades. TSH, FT3 and FT4 levels were measured by electrochemiluminescence immunoassay. Results: The mean age of our patients was 40.3 ± 14.2 years. CLD patients had statistically significant lower level of FT3 ( P < 0.001) and FT4 ( P < 0.001) but had higher level of TSH ( P < 0.001) compared with the controls. CLD with HE (n = 32) had significantly lower lever of FT3 ( P < 0.001) compared with CLD without HE ( n = 68), whereas there was no statistically significant difference in FT4 ( P = 0.10) and TSH ( P = 0.60) levels. The most common abnormality seen was low T3 (low FT3) syndrome in 31% cases, 50% of CLD with HE. In all CLD patients, FT3 and FT4 negatively correlated, but TSH positively correlated with alanine transaminase, albumin, prothrombin time (PT), CTP, and MELD score. Conclusion: The mean FT3 and FT4 levels were significantly decreased and mean TSH levels were significantly increased in CLD patients. Level of FT3, FT4, and TSH correlated with severity of liver disease, level of FT3 can be used as prognostic marker in CLD patients.