Thyroid Dysfunction in Patients with Liver Cirrhosis and its Association with the Severity of Liver Disease: A Cross-sectional Study

Abstract

Introduction: There exists a complex relation between the thyroid hormones and liver physiology in health and disease. The liver along with the thyroid gland play a significant role in the conversion of inactive Thyroxine (T4 ) to active Triiodothyronine (T3 ). The most common thyroid hormone profile in cirrhosis of liver is a low total T3 and free T3 , secondary to reduced activity of deiodinase type 1 and increased conversion to rT3 . Aim: To assess the association between the thyroid hormone levels and severity of liver disease, expressed in terms of child pugh score in tertiary care hospital in Goa. Materials and methods: The cross-sectional observational study included hundred patients with liver cirrhosis, admitted at a tertiary care hospital in Goa, from October 2019 to September 2020. The thyroid hormone levels were estimated from an early morning fasting blood sample within 24 hours of admission, once the patient satisfied the inclusion criteria. The Child Turgott Pugh scoring system was used to classify patients as per their severity of liver disease. The data was entered and analysed in Statistical Package for Social Sciences (SPSS) software version 14.0. Results: There were 95 males and 5 females. The study showed low mean levels of total T4 and free T3 in patients with cirrhosis of liver, which was significantly associated with Child Pugh classes of liver dysfunction. There was an association between levels of free T3 and the classes of Child Pugh score. The difference in the mean levels of TSH, total T3 and free T4 across the Child Pugh classes were not statistically significant. Conclusion: The study showed low free T3 levels in patients with cirrhosis of liver as seen in similar studies done in various settings. Thus, Thyroid Function Tests (TFTs) especially free T3 levels have a considerable potential to be used an independent predictor or a proxy to prognosis in patients with liver cirrhosis.