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Disfunción tiroidea oculta en pacientes ambulatorios con cirrosis hepática / Occult thyroid dysfunction in outpatients with liver cirrhosis
Resumen
Resumen
Introducción: se han identificado diversas alteraciones en la función tiroidea en pacientes con cirrosis hepática (CH).
Objetivo: hacer un cribado de enfermedad tiroidea en pacientes adultos con CH.
Material y Métodos: estudio transversal. Se midieron los niveles séricos de hormona estimulante de la tiroides (TSH) y tetrayodotironina libre (T4) y se compararon según la etiología de la cirrosis, el sexo, el modelo de enfermedad hepática en etapa terminal (MELD) y la clase de Child-Pugh (C-P).
Resultados: la etiología más frecuente fue el virus de la hepatitis C (45%), seguida de la enfermedad del hígado graso no alcohólico (17%). Encontramos disfunción tiroidea en el 36% de los pacientes. La alteración más frecuente fue el hipotiroidismo subclínico (34%). Los pacientes con cirrosis inducida por alcohol presentaron la frecuencia más alta de hipotiroidismo subclínico (45%) y los niveles de TSH fueron más altos en pacientes con cirrosis por enfermedad autoinmune y en aquellos con cirrosis inducida por alcohol.
Conclusiones: no encontramos correlación entre los niveles de hormonas tiroideas, la edad, la puntuación MELD o C-P. Nuestros resultados mostraron que la disfunción tiroidea primaria oculta es frecuente en pacientes ambulatorios con CH, independientemente de la edad, etiología o reserva hepática. El hipotiroidismo subclínico fue la principal alteración y se presentó con mayor frecuencia en pacientes con cirrosis inducida por alcohol. Son necesarios estudios longitudinales para conocer el impacto del hipotiroidismo subclínico en la evolución clínica de los pacientes con cirrosis.
Abstract
Background: Several alterations in thyroid function have been identified in patients with liver cirrhosis (LC).
Objective: To carry out a thyroid disease screening in adult patients with LC.
Material and methods: A cross-sectional study. Serum levels of thyroid-stimulating hormone (TSH) and free-tetraio-dothyronine (T4) were measured, and compared according to etiology of the cirrhosis, sex, model of end-stage liver disease (MELD) score, and Child-Pugh (C-P) class.
Results: The most frequent etiology was hepatitis C virus (45%), followed by non- alcoholic fatty liver-disease (17%). We found thyroid dysfunction in 36% of the patients. The most frequent alteration was subclinical hypothyroidism (34%). Patients with alcohol-induced cirrhosis had the highest frequency of subclinical hypothyroidism (45%) and TSH levels were higher in patients with cirrhosis due to autoimmune disease and in those with alcohol-induced cirrhosis.
Conclusion: We found no correlation between thyroid hormone levels, age, MELD score, or C-P. Our results showed that occult primary thyroid dysfunction is frequent in outpatients with LC, regardless of age, etiology, or liver reserve. Subclinical hypothyroidism was the main alteration and presented more frequently in patients with alcohol-induced cirrhosis. Longitudinal studies are needed to know the impact of subclinical hypothyroidism on the clinical progression of patients with cirrhosis.
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DOI: https://doi.org/10.24875/10.5281/zenodo.10814357
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