The Influence of End-Stage Liver Disease and Liver Transplantation on Thyroid Hormones

Penteado, Karla Rocha; Coelho, Júlio Cézar Uili; Parolin, Mônica Beatriz; Matias, Jorge Eduardo Fouto; Freitas, Alexandre Coutinho Teixeira de

doi:10.1590/s0004-28032015000200009

Cited by 12 publications

(8 citation statements)

References 15 publications

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“…Although the relationship among hypothyroidism, cirrhosis, and HCC development has been emphasized in the literature, the issue is still controversial due to the different results obtained by different studies. [ 8 , 9 , 11 – 13 ] Our study demonstrated the presence of hypothyroidism in patients with cirrhosis and HCC. Interestingly, our study revealed that hypothyroidism levels were significantly different among patients with cirrhosis and HCC.…”

Section: Discussionmentioning

confidence: 75%

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Can hypothyroidism be a protective factor for hepatocellular carcinoma in cirrhosis?

Sahin¹,

Oral

Türker

et al. 2020

Medicine

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Despite many studies, the molecular mechanisms of hepatocellular carcinoma (HCC) development remain unclear. Thyroid hormone (TH) levels may vary in many chronic diseases including cirrhosis. The aim of this study was to evaluate TH status in patients with cirrhosis and HCC and to investigate the relationship between THs and HCC development. Five hundred seventy-seven patients with cirrhosis who applied to Demiroğlu Bilim University, Faculty of Medicine, Gastroenterology Department between 2004 and 2019 were included the study. Three hundred sixty-seven patients who applied to Internal Medicine Unit for general health check-up were included in the study as healthy control group. Demographic, laboratory, and imaging findings of study groups were retrospectively reviewed and recorded from hospital information system. In the cirrhosis group, 252 patients had HCC (43.67%), and 325 patients had non-HCC cirrhosis (56.33%). Free thyroxine (FT4) levels were higher in the control group than in the cirrhotic group but there was no significant difference ( P = .501). Thyroid-stimulating hormone (TSH) and FT4 levels were similar between groups, while free triiodothyronine (FT3) levels were significantly different between HCC group, non-HCC cirrhosis group, and control group ( P = .299 for TSH, P = .263 for FT4, P < .001 for FT3). FT3 levels were significantly higher in HCC group than non-HCC cirrhosis group, but significantly lower than control group ( P < .05). Our study confirmed the presence of hypothyroidism in cirrhosis patients and clearly demonstrated a strong relationship between FT3 levels and HCC development.

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Section: Discussionmentioning

confidence: 75%

“…[ 7 ] Although some studies have found an inverse relationship between serum T3 concentrations and the severity of liver dysfunction, many others have not found clinical findings of hypothyroidism in patients with cirrhosis. [ 8 , 9 ]…”

Section: Introductionmentioning

confidence: 99%

Can hypothyroidism be a protective factor for hepatocellular carcinoma in cirrhosis?

Sahin¹,

Oral

Türker

et al. 2020

Medicine

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“…Studies have demonstrated that thyroid dysfunction is associated with various conditions such as heart failure [ 12 ], cerebrovascular disorders [ 13 ], kidney disease [ 14 ], and liver cirrhosis [ 15 ]. However, it is still unclear if TSH level holds prognostic value for patients with HBV-related ACLF [ 15 , 24 , 25 ]. In this large-scale observational study of 1,862 patients with HBV-related ACLF, we found that TSH levels before treatment were correlated with reduced 30-day and 90-day survival, and that TSH level was an independent predictor of 30-day and 90-day outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, one of the studies [ 23 ] only included 75 patients with ACLF, and in the other study [ 22 ] the follow-up period was only 30 days. In addition, other studies have indicated that TSH level has no predictive value on the outcomes of patients with advanced liver diseases [ 15 , 24 , 25 ]. Therefore, whether the level of TSH can predict the outcome of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) is controversial.…”

Section: Introductionmentioning

confidence: 99%

The impact of serum thyroid-stimulation hormone levels on the outcome of hepatitis B virus related acute-on-chronic liver failure: an observational study

et al. 2022

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Background Thyroid dysfunction has been reported in severe liver diseases. The aim of this study was to analyze the impact of serum thyroid-stimulation hormone (TSH) levels on the prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). Methods This retrospective cohort study included 1,862 patients with HBV-related ACLF. Risk factors associated with 30-day and 90-day survival, hazard ratios (HRs), and 95% confidence intervals (CIs) for TSH were estimated using Cox proportional hazards regression. The Area Under the ROC curve (AUROC) analysis was carried out, and the cut-off values were calculated. After grouping by the cut-off value, survival was compared between the groups using the log-rank test. This study data is from the “Survival Cohort Study (SCS)”, which has been registered at ClinicalTrials.gov (NCT03992898). Results Multivariate analysis indicated that an elevated TSH level was a highly significant predictor for 30-day survival (HR = 0.743, 95% CI: 0.629–0.878, P < 0.001) and 90-day survival (HR = 0.807, 95% CI: 0.717–0.909, P < 0.001). The AUROC of TSH level for 30-day and 90-day mortality were 0.655 and 0.620, respectively, with the same best cut-off values of 0.261 µIU/mL. Log-rank test showed that the group with higher TSH level had higher 30-day (78.5%, 95% CI: 76.1%-80.9% vs. 56.9%, 95% CI: 53.4%-60.4%; P < 0.001) and 90-day survival rate (61.5%, 95% CI: 58.6%-64.4% vs. 42.8%, 95% CI: 39.3%-46.3%; P < 0.001). Similar findings were observed in subgroups analysis. After adjusting for age and other risk factors, the higher level of TSH remained associated with 30-day survival (HR = 0.602, 95% CI: 0.502–0.721, P < 0.001) and 90-day survival (HR = 0.704, 95% CI, 0.609–0.814, P < 0.001). Conclusions Serum TSH level significantly correlate with HBV-related ACLF patients’ survival and may be of value for predicting 30-day and 90-day survival of patients with HBV-related ACLF.

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“…However, previous studies have shown the importance of ESS in several pathologies, such as acute myocardial infarction, major burns, cancer, cirrhosis and chronic kidney disease. ( 22 - 24 )…”

Section: Discussionmentioning

confidence: 99%

Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study

Pontes¹,

Rocha²,

Medeiros³

et al. 2022

RBTI

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Objective To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability. Methods This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará . One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine. Results Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days). There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death. Conclusion The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

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The Influence of End-Stage Liver Disease and Liver Transplantation on Thyroid Hormones

Cited by 12 publications

References 15 publications

Can hypothyroidism be a protective factor for hepatocellular carcinoma in cirrhosis?

Can hypothyroidism be a protective factor for hepatocellular carcinoma in cirrhosis?

The impact of serum thyroid-stimulation hormone levels on the outcome of hepatitis B virus related acute-on-chronic liver failure: an observational study

Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study

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