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BACKGROUNDA complex relationship exists between the thyroid gland and the liver in both health and disease. Many studies have been carried out on liver disease patients assessing their thyroid status, mostly in European countries. Most of these studies are limited by the number of patients in these studies. This study tries to find out the relationship between thyroid function and chronic liver disease in a tertiary care hospital in India. Aim-To study the thyroid function abnormalities in chronic liver disease and its relationship with liver function. MATERIALS AND METHODSAfter obtaining clearance from the Institutional Review Board, this hospital-based cross-sectional study was conducted in patients admitted in the ward under the Department of General Medicine. A total of 150 subjects were selected after explaining the purpose of the study and the procedure in detail and after obtaining their consent in written format. Data collection was done by history, clinical examination and investigations. With physical examination aided by abdominal imaging, patients who had ascites were graded into mild, moderate and severe refractory ascites. Hepatic encephalopathy was graded into grade 0 to 4 according to We st Haven criteria. RESULTS24.6% of the study population showed abnormalities in thyroid function tests. The commonest was sick euthyroid syndrome in 18% of patients. Subclinical hypothyroidism was present in 4.7% of patients. Thyroid hormone levels had significant correlation with various liver function indices. Serum levels of total T3 and free T3 had significant positive correlation with serum albumin level and negative correlation with serum bilirubin and INR value. Free T4 had a weak negative correlation with serum bilirubin. Serum T3 and Free T3 were found to be decreased in patients with hepatic encephalopathy and ascites according to the severity. When severity of liver dysfunction was assessed using Child-Pugh score, it was found that there was statistically significant decrease in serum T3 and FT3 levels as the severity of liver dysfunction increased. CONCLUSIONChronic liver diseases were associated with abnormalities in thyroid function tests, although most of the patients remained clinically euthyroid. Serum T3 and FT3 levels had an inverse correlation with the severity of liver dysfunction.
BACKGROUNDA complex relationship exists between the thyroid gland and the liver in both health and disease. Many studies have been carried out on liver disease patients assessing their thyroid status, mostly in European countries. Most of these studies are limited by the number of patients in these studies. This study tries to find out the relationship between thyroid function and chronic liver disease in a tertiary care hospital in India. Aim-To study the thyroid function abnormalities in chronic liver disease and its relationship with liver function. MATERIALS AND METHODSAfter obtaining clearance from the Institutional Review Board, this hospital-based cross-sectional study was conducted in patients admitted in the ward under the Department of General Medicine. A total of 150 subjects were selected after explaining the purpose of the study and the procedure in detail and after obtaining their consent in written format. Data collection was done by history, clinical examination and investigations. With physical examination aided by abdominal imaging, patients who had ascites were graded into mild, moderate and severe refractory ascites. Hepatic encephalopathy was graded into grade 0 to 4 according to We st Haven criteria. RESULTS24.6% of the study population showed abnormalities in thyroid function tests. The commonest was sick euthyroid syndrome in 18% of patients. Subclinical hypothyroidism was present in 4.7% of patients. Thyroid hormone levels had significant correlation with various liver function indices. Serum levels of total T3 and free T3 had significant positive correlation with serum albumin level and negative correlation with serum bilirubin and INR value. Free T4 had a weak negative correlation with serum bilirubin. Serum T3 and Free T3 were found to be decreased in patients with hepatic encephalopathy and ascites according to the severity. When severity of liver dysfunction was assessed using Child-Pugh score, it was found that there was statistically significant decrease in serum T3 and FT3 levels as the severity of liver dysfunction increased. CONCLUSIONChronic liver diseases were associated with abnormalities in thyroid function tests, although most of the patients remained clinically euthyroid. Serum T3 and FT3 levels had an inverse correlation with the severity of liver dysfunction.
Background: Thyroid dysfunction has been reported in association with several chronic diseases, including advanced liver disease. This disease and its management are often neglected in clinical practice. The bundle discussed here is aimed at proposing systematic assistance according to the best evidence-based practices available. Objective: To construct and validate a bundle to evaluate thyroid function in patients with liver cirrhosis. Methods: The process of constructing and validating the bundle was carried out in the following stages: a) bibliographic survey; b) bundle elaboration; and c) content validation. The bibliographic survey was carried out in an integrative review about evidence related with the thyroid function of patients with liver cirrhosis. The findings from the integrative review were considered as supporting evidence for the elaboration of the bundle. The tool then created used accessible language and was evidence-based, ensuring that information was based on current literature. Results: The bundle was restructured to provide guidance on the management of patients with liver dysfunctions, including: cirrhosis due to general causes, cirrhosis due to hepatitis C, non-alcoholic fatty liver disease, primary biliary cholangitis, and hepatocellular carcinoma. The orientations in the bundle included: exams to be requested to screen for thyroid disorders, and guidance about the treatment of these dysfunctions and their associated complications. We analyzed specialist evaluation of the bundle using the Content Validity Index (CVI). We carried out a binomial test to evaluate consistency and specialist agreement regarding the items in the bundle, considering values >0.61 as a good level. The items in the bundle were considered to be valid (CVI >0.80). The general CVI of the instrument was 0.95 (CI95%: 0.91-0.98). Conclusion: The bundle was considered valid to facilitate medical decision making, aiding physicians to manage, in a practical and effective approach, the thyroid function of patients with liver cirrhosis. This tool should not be used as a replacement for individual, evaluation of the physician providing assistance. We recommend the structured bundle to be added to medical practice, considering its simple application, low cost, and potential to contribute for the management of these patients.
Background and Aim: The levels of thyroid hormones and their binding proteins are altered in patient with cirrhosis. We aim to study the changes in triiodothyronine level in HCV related cirrhosis and its correlation to the severity of liver decompensation. Patients and Methods: This study included seventy two patients with HCV related cirrhosis in three groups Group I: 24 patients with Child A class Group II: 24 patients with Child B and C classes without hepatic encephalopathy Group III: 24 patients with Child B and C classes with hepatic encephalopathy. Results: T3 level was significantly lower in group III than group I and II (0.74 ng/ml vs 1 and 1.3 ng/ml in group II and I in succession). The correlation between Child's score and T3 level was highly significant (r = −0.64, P < 0.001). Conclusion: Triiodothyronine level is lower in cirrhosis and its level is correlated to the severity of decompensation.
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