The interplay between thyroid and liver: implications for clinical practice

Piantanida, Eliana; Ippolito, Silvia; Gallo, Daniela; Masiello, E.; Premoli, Paola; Cusini, Claudio; Rosetti, S; Sabatino, Jessica; Segato, S.; Trimarchi, Francesco; Bartalena, Luigi; Tanda, Maria Laura

doi:10.1007/s40618-020-01208-6

Cited by 94 publications

(108 citation statements)

References 144 publications

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“… 58 Liver also extracts 5-10% of thyroxine in plasma during a single passage, and it synthesizes major transport proteins for thyroid hormones, including thyroxine-binding globulin, transtyrethin and albumin, which provide a pool for rapid exchange of circulating thyroid hormones. 57 However, these changes in liver and thyroid metabolism in NAFLD would not have a significant influence on thyroid function…”

Section: Pathophysiological Backgroundmentioning

confidence: 99%

“…10,27 On the other hand, liver plays a significant role in metabolism of thyroid hormones and liver disfunction could cause variations in the bioavailability of such. 57 Thyroid hormone metabolism is regulated by iodothyronine seleno-deiodinase enzymes. Two of these enzymes are expressed in liver: type 1, which converts thyroxine to triiodothyronine, thus activating it; and type 3, which prevents activation of thyroxine by converting it to an inactive metabolite reverse triiodothyronine.…”

Section: Pathophysiological Backgroundmentioning

confidence: 99%

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Hypothyroidism and Nonalcoholic Fatty Liver Disease: Pathophysiological Associations and Therapeutic Implications

Kizivat

Marić

Mudri

et al. 2020

Journal of Clinical and Translational Hepatology

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Nonalcoholic fatty liver disease (NAFLD) is a complex clinical entity which can be secondary to many other diseases including hypothyroidism, characterized by lowering of thyroid hormones and increased thyroid stimulating hormone (TSH). A lot of emerging data published recently advocates the hypothesis that hypothyroid induced NAFLD could be a separate clinical entity, even suggesting possible treatment options for NAFLD involving substitution therapy for hypothyroidism along with lifestyle modifications. In addition, a whole new field of research is focused on thyromimetics in NAFLD/NASH treatment, currently in phase 3 clinical trials. In this critical review we summarized epidemiological and pathophysiological evidence linking these two clinical entities and described specific treatment options with the accent on promising new agents in NAFLD treatment, specifically thyroid hormone receptor (THR) agonist and its metabolites.

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Section: Pathophysiological Backgroundmentioning

confidence: 99%

Section: Pathophysiological Backgroundmentioning

confidence: 99%

Hypothyroidism and Nonalcoholic Fatty Liver Disease: Pathophysiological Associations and Therapeutic Implications

Kizivat

Marić

Mudri

et al. 2020

Journal of Clinical and Translational Hepatology

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“…The association between hyperthyroidism and liver dysfunction has been well described 4 . Changes in liver function testing are frequently reported in the setting of hyperthyroidism 5 .…”

Section: Introductionmentioning

confidence: 99%

Severe hyperthyroidism without symptoms due to nonthyroidal illness in a child with acute hepatitis: case report and literature review

Yeliosof

Marshall

2020

Annals of the New York Academy of Sciences

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While liver enzyme changes are frequently reported in hyperthyroidism, liver dysfunction itself can lead to alterations in thyroid hormone metabolism. However, the exact relationship between hyperthyroidism and liver dysfunction is unclear. We report an 11‐year‐old boy presenting with acute hepatitis of unknown etiology, who was incidentally found to have asymptomatic biochemical hyperthyroidism. Despite significant total and free T4 elevation, clinical evidence of thyrotoxicosis was absent. Thyroid I‐123 uptake was also reduced. Additional testing revealed slight T3 elevation and significant rT3 elevation. Graves' and Hashimoto's thyroiditis testing was negative. We hypothesize that the biochemical hyperthyroidism was due to transient thyroiditis. Although an etiology for the boy's hepatitis was never determined, and an undiagnosed infectious etiology causing subacute thyroiditis was considered, subsequent testing showing positive thyroid peroxidase antibodies, suggesting autoimmune Hashimoto's thyroiditis as the likely cause of the hyperthyroidism. We believe, furthermore, that the absence of symptoms was the result of concurrent nonthyroidal illness resulting in the biochemical findings of slight T3 elevation and significant rT3 increase despite significant T4 elevation.

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“…These medications have been demonstrated to reduce hospital stay, and accelerate recovery time from disease, especially in moderate cases; however, their efficacy in severe cases could be significantly different according to the results of different trials [118,119]. Lopinavir and ritonavir may accelerate the metabolism of levothyroxine, diminishing levothyroxine's therapeutic effect [120][121][122].…”

Section: Does Medical Management Of Covid-19 Interfere With Thyroid Fmentioning

confidence: 99%

Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects

Lisco

Tullio

Jirillo

et al. 2021

J Endocrinol Invest

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Background Thyroid dysfunction has been observed in patients with COVID-19, and endocrinologists are requested to understand this clinical issue. Pandemic-related restrictions and reorganization of healthcare services may affect thyroid disease management. Objective and methods To analyze and discuss the relationship between COVID-19 and thyroid diseases from several perspectives. PubMed/MEDLINE, Google Scholar, Scopus, ClinicalTrial.gov were searched for this purpose by using free text words and medical subject headings as follows: “sars cov 2”, “covid 19”, “subacute thyroiditis”, “atypical thyroiditis”, “chronic thyroiditis”, “hashimoto’s thyroiditis”, “graves’ disease”, “thyroid nodule”, “differentiated thyroid cancer”, “medullary thyroid cancer”, “methimazole”, “levothyroxine”, “multikinase inhibitor”, “remdesivir”, “tocilizumab”. Data were collected, analyzed, and discussed to answer the following clinical questions: “What evidence suggests that COVID-19 may induce detrimental consequences on thyroid function?"; "Could previous or concomitant thyroid diseases deteriorate the prognosis of COVID-19 once the infection has occurred?”; “Could medical management of thyroid diseases influence the clinical course of COVID-19?”; “Does medical management of COVID-19 interfere with thyroid function?”; “Are there defined strategies to better manage endocrine diseases despite restrictive measures and in-hospital and ambulatory activities reorganizations?”. Results SARS-CoV-2 may induce thyroid dysfunction that is usually reversible, including subclinical and atypical thyroiditis. Patients with baseline thyroid diseases are not at higher risk of contracting or transmitting SARS-CoV-2, and baseline thyroid dysfunction does not foster a worse progression of COVID-19. However, it is unclear whether low levels of free triiodothyronine, observed in seriously ill patients with COVID-19, may worsen the disease's clinical progression and, consequently, if triiodothyronine supplementation could be a tool for reducing this burden. Glucocorticoids and heparin may affect thyroid hormone secretion and measurement, respectively, leading to possible misdiagnosis of thyroid dysfunction in severe cases of COVID-19. High-risk thyroid nodules require a fine-needle aspiration without relevant delay, whereas other non-urgent diagnostic procedures and therapeutic interventions should be postponed. Discussion Currently, we know that SARS-CoV-2 could lead to short-term and reversible thyroid dysfunction, but thyroid diseases seem not to affect the progression of COVID-19. Adequate management of patients with thyroid diseases remains essential during the pandemic, but it could be compromised because of healthcare service restrictions. Endocrine care centers should continuously recognize and classify priority cases for in-person visits and therapeutic procedures. Telemedicine may be a useful tool for managing patients not requiring in-person visits.

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The interplay between thyroid and liver: implications for clinical practice

Cited by 94 publications

References 144 publications

Hypothyroidism and Nonalcoholic Fatty Liver Disease: Pathophysiological Associations and Therapeutic Implications

Hypothyroidism and Nonalcoholic Fatty Liver Disease: Pathophysiological Associations and Therapeutic Implications

Severe hyperthyroidism without symptoms due to nonthyroidal illness in a child with acute hepatitis: case report and literature review

Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects

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