Risk Factors of Thyroid Dysfunction in Patients with Acute Pancreatitis and Predictive Value of TSH for Disease Severity

Background: Patients with acute pancreatitis (AP) commonly present with thyroid dysfunction in clinic. The present study aimed to characterize thyroid dysfunction in AP patients, identify the risk factors, assess its dynamics during AP resolution and evaluate its value for predicting AP severity. Methods: A total of 182 AP patients and 61 age- and gender-matched patients with chronic pancreatitis (CP) were enrolled. Demographic characteristics, biochemical parameters and thyroid function were collected. Results: AP patients had an average age of 53.3± 16.7 years and 61.5% were males; CP patients had an average age of 52.7± 11.9 years and 59.0% were males. Compared with CP group, the level of T3, T4, FT3 and TSH was significantly lower in AP group. A high prevalence of thyroid dysfunction (87.4%), manifested as decreased thyroid hormones and TSH, was observed in AP patients. The extent of hormone reduction was progressively exacerbated with increasing the disease severity. Albumin (Alb) was independently positive correlation, and hs-CRP and lactate (Lac) were independently negatively correlated with thyroid function. The levels of thyroid hormones and TSH increased during AP resolution. TSH demonstrated superior predictive value for moderate-to-severe AP compared to traditional markers (hs-CRP, Alb, Ca) and established severity scores (APACHE II, BISAP). The cut-off value of TSH was 0.42 μIU/mL with the highest AUC (0.772 (0.693– 0.851)) and the highest Youden’s index (0.478). Conclusion: Thyroid dysfunction was common in AP patients, characterized by a reduction in thyroid hormones and TSH. Lower Alb and higher hs-CRP and Lac were independent risk factors of thyroid dysfunction. During AP resolution, thyroid dysfunction could spontaneously recover. Furthermore, a low level of TSH at admission showed promising predictive value for moderate to severe AP in the early stage. Keywords: thyroid dysfunction, thyroid stimulating hormone, thyroid hormone, predictive value, acute pancreatitis