Abstract
Abnormality of thyroid hormones in liver diseases is common, but data is lacking in patients with type A hepatic encephalopathy (HE). The present study was aimed to determine whether there was an abnormality in thyroid hormones among patients with type A HE. We measured the levels of thyroid hormones in 36 acute liver failure (ALF) patients with type A HE and in 29 acute liver injury patients (international normalized ratio, INR ≥ 1.5) without encephalopathy as control. The clinical parameters associated with abnormality of thyroid hormones were evaluated. ALF patients with type A HE exhibited decreased TSH levels compared to patients without encephalopathy (0.17 vs 1.08 μIU/mL, P < 0.001). There was no difference in T3 and T4 levels (both total and free) between the two groups. The logistic regression analysis identified type A HE as an independent related factor for the occurrence of low TSH (Odds Ratio = 12.32) in patients with ALF. Correlation analysis showed that there was an inverse correlation between TSH level and the grade of encephalopathy (r = −0.795). Furthermore, patients with low TSH depicted poor survival rate than those with normal TSH level (29.3% vs 44.1%, P = 0.003). Patients with type A HE exhibited subclinical central hypothyroidism, and had significant decreased TSH level, which had inverse correlation with the grade of encephalopathy. The reduced TSH was associated with poor survival rate.
Highlights
Liver plays an important role in the metabolism of thyroid hormones
hepatic encephalopathy (HE) is a common complication of severe liver disease, which is grouped into three categories: type A is associated with acute liver failure (ALF), type B is associated with portal-systemic bypass without liver disease, and type C is HE that occurs in cirrhotic patients
The ‘‘sick euthyroid’’ usually manifested as primary hypothyroidism, and the abnormalities were often presented as decreased levels of T3 and T4, and the thyroid stimulating hormone (TSH) level is usually normal or slightly increased [9]
Summary
Patients with acute or chronic liver injury is often depicted abnormality of thyroid hormones, which is associated with liver dysfunction and poor prognosis [1,2,3,4]. Data about alteration of thyroid hormones in patients with hepatic encephalopathy (HE) are scanty. Studies on thyroid hormones in patients with type C HE had been reported. There is no report on alteration of thyroid hormones in patients with type A HE. The pathogenesis and manifestation of type A and type C HE are different [7, 8] It is not clear whether type A HE has any effect on thyroid function. To explore alteration of thyroid hormones in type A HE patients will widened our knowledge of type A HE and help to find the clue of new therapy
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