Occult thyroid dysfunction in outpatients with liver cirrhosis

Authors

  • Nayeli Ortiz-Olvera <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional Siglo XXI, Hospital de Especialidades &ldquo;Dr. Bernardo Sep&uacute;lveda&nbsp;Guti&eacute;rrez&rdquo;, Servicio de Gastroenterolog&iacute;a. Ciudad de M&eacute;xico, M&eacute;xico.</p> http://orcid.org/0000-0002-3406-2918
  • Araceli Muñoz-Bautista <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional Siglo XXI, Hospital de Especialidades &ldquo;Dr. Bernardo Sep&uacute;lveda&nbsp;Guti&eacute;rrez&rdquo;, Servicio de Gastroenterolog&iacute;a. Ciudad de M&eacute;xico, M&eacute;xico.</p> http://orcid.org/0000-0001-8520-4675
  • Mario Molina-Anaya <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional Siglo XXI, Hospital de Especialidades &ldquo;Dr. Bernardo Sep&uacute;lveda&nbsp;Guti&eacute;rrez&rdquo;, Servicio de Endocrinolog&iacute;a. Ciudad de M&eacute;xico, M&eacute;xico.</p> http://orcid.org/0009-0005-7917-4701
  • Rita A. Gómez-Díaz <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional Siglo XXI, Hospital de Especialidades &ldquo;Dr. Bernardo Sep&uacute;lveda&nbsp;Guti&eacute;rrez&rdquo;, Unidad de Investigaci&oacute;n M&eacute;dica en Epidemiolog&iacute;a Cl&iacute;nica. Ciudad de M&eacute;xico, M&eacute;xico.</p> http://orcid.org/0000-0002-2191-4931
  • Segundo Morán-Villota <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional Siglo XXI, Hospital de Pediatr&iacute;a, Laboratorio de Investigaci&oacute;n en&nbsp;Gastro-Hepatolog&iacute;a. Ciudad de M&eacute;xico, M&eacute;xico.</p> http://orcid.org/0000-0001-6833-2392

DOI:

https://doi.org/10.5281/zenodo.10814357

Keywords:

Hypothyroidism, Cross-Sectional Studies, hepatitis Autoimmune, Liver Cirrhosis

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.

Downloads

Download data is not yet available.

Author Biography

  • Nayeli Ortiz-Olvera, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional Siglo XXI, Hospital de Especialidades &ldquo;Dr. Bernardo Sep&uacute;lveda&nbsp;Guti&eacute;rrez&rdquo;, Servicio de Gastroenterolog&iacute;a. Ciudad de M&eacute;xico, M&eacute;xico.</p>

    Nombre                                                        Nayeli Xochiquetzal Ortiz Olvera

    Puesto  laboral actual                      Servicio de Gastroenterología, Hospital de Especialidades, CMN Siglo XXI, IMSS, México, DF Noviembre 2006 - presente.
    Profesor Asociado "A", Asignatura Medicina General I (Gastroenterología), Facultad de Medicina, UNAM.
    Investigador Asociado B, IMSS. Enero 2012-  2023.          

    e-mail                                                nayelixoortiz@yahoo.com.mx

    Entrenamiento Externo                   Gastroenterología y Hepatología, Hospital Ramon y Cajal, Madrid España.Septiembre-Octubre-2002. Estancia formativa en motilidad digestiva en el Institut Clínic of Malalties Digestives i Metabolism del Hospital Clinic y Provincial de Barcelona. Barcelona, España. Enero-Marzo 2006. Estancia formativa en motilidad Gastrointestinal (high-resolution manometry), Hospital Universitario Clínico San Carlos, Madrid, España (octubre-noviembre 2012).

    Investigador Asociado B del IMSS.

    Investigador Nivel I del Sistema Nacional de Investigadores.

    Publicaciones: 19 articulos

References

Harb S, Garg MK, Puri P, et al. Assessment of thyroid and gonadal function in liver diseases. Indian J Endocrinol Metab. 2015;19(1):89-94. doi: 10.4103/2230- 8210.131761.

Iantanida E, Ippolito S, Gallo D, et al. The interplay between thyroid and liver: implications for clinical practice. J Endocrinol Invest. 2020;43:885-99. doi: 10.1007/s40618-020-01208-6.

Thilak MR, Shetty SM, Kotian CM, et al. Serum total triiodo-thyronine (T3) as a predictor of mortality and morbidity in critically ill patients and its correlation of predictability with acute physiology and chronic health evaluation II score: A prospective observational study. Int J Crit Illn Inj Sci. 2021;11(2):61-6. doi: 10.4103/IJCIIS.IJCIIS_88_20.

Vincken S, Reynaert H, Schiettecatte J, et al. Liver cirrhosis and thyroid function: Friend or foe? Acta Clin Belg. 2017;72(2):85-90. doi: 10.1080/17843286.2016.1215641.

Punekar P, Sharma AK, Jain A. A Study of Thyroid Dysfunction in Cirrhosis of Liver and Correlation with Severity of Liver Disease. Indian J Endocrinol Metab. 2018;22(5):645-50. doi:10.4103/ijem.IJEM_25_18.

Zeng X, Li B, Zou Y. The relationship between non-alcoholic fatty liver disease and hypothyroidism: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100(17):e25738. doi: 10.1097/MD.0000000000025738.

Garduño-Garcia JJ, Alvirde-Garcia U, López-Carrasco G, et al. TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects. Eur J Endocrinol. 2010;163(2):273-8. doi: 10.1530/EJE-10- 0312.

Ruggeri RM, Giovinazzo S, Barbalace MC, et al. Influence of Dietary Habits on Oxidative Stress Markers in Hashimoto’s Thyroiditis. Thyroid. 2021;31(1):96-105. doi: 10.1089/thy.2020.0299.

Anase DM, Gosav EM, Neculae E, et al. Hypothyroidism-Induced Nonalcoholic Fatty Liver Disease (HIN): Mechanisms and Emerging Therapeutic Options. Int J Mol Sci. 2020;21(16):5927. doi: 10.3390/ijms21165927.

Kim D, Kim W, Joo SK, et al. Subclinical Hypothyroidism and Low-Normal Thyroid Function Are Associated With Nonalcoholic Steatohepatitis and Fibrosis. Clin Gastroenterol Hepatol. 2018;16(1):123-31.e1. doi: 10.1016/j.cgh.2017.08.014.

Sinha RA, Singh BK, Yen PM. Thyroid hormone regulation of hepatic lipid and carbohydrate metabolism. Trends Endocrinol Metab. 2014;25(10):538-45. doi: 10.1016/j.tem.2014.07.001.

LeFevre ML; U.S. Preventive Services Task Force. Screening for thyroid dysfunction: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;162(9):641-50. doi: 10.7326/M15-0483.

Garber JR, Cobin RH, Gharib H, et al; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988-1028. doi: 10.4158/EP12280.GL.

Méndez-Sánchez N, Zamarripa-Dorsey F, Panduro A, et al. Current trends of liver cirrhosis in Mexico: Similitudes and differences with other world regions. World J Clin Cases. 2018;6(15):922-30. doi: 10.12998/wjcc.v6.i15.922.

Rivière B, Jaussent A, Macioce V, et al; COMET study group. The triglycerides and glucose (TyG) index: A new marker associated with nonalcoholic steatohepatitis (NASH) in obese patients. Diabetes Metab. 2022;48(4):101345. doi: 10.1016/j.diabet.2022.101345.

Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99:39- 51.

Juárez-Cedillo T, Basurto-Acevedo L, Vega-García S, et al. Prevalence of thyroid dysfunction and its impact on cognition in older mexican adults: (SADEM study). J Endocrinol Invest. 2017;40(9):945-52. doi: 10.1007/s40618-017-0654-6.

Piantanida E, Ippolito S, Gallo D, et al. The interplay between thyroid an.d liver: implications for clinical practice. J Endocrinol Invest. 2020;43(7):885-99. doi:10.1007/s40618-020-01208-6.

Patira NK, Salgiya N, Agrawal D. Correlation of Thyroid Function Test with Severity of Liver Dysfunction in Cirrhosis of Liver. J Assoc Physicians India. 2019;67(3):51-4.

Kumar KV, Pawah AK, Manrai M. Occult endocrine dysfunction in patients with cirrhosis of liver. J Family Med Prim Care. 2016; 5(3):576-80. doi: 10.4103/2249- 4863.197293.

Maheshwari A, Thuluvath PJ. Endocrine diseases and the liver. Clin Liver Dis. 2011;15(1):55-67. doi: 10.1016/j.cld.2010.09.008.

Parés A. Primary biliary cholangitis. Med Clin (Barc). 2018;151(6):242-9. doi: 10.1016/j.medcli.2017.12.021.

Nieri S, Riccardo GG, Salvadori G, et al. Primary biliary cirrhosis and Graves’ disease. J Clin Gastroenterol. 1985;7(5):434-7. doi: 10.1097/00004836- 198510000-00014.

Sucher E, Sucher R, Gradistanac T, et al. Autoimmune Hepatitis-Immunologically Triggered Liver Pathogenesis-Diagnostic and Therapeutic Strategies. J Immunol Res. 2019;2019:9437043. doi: 10.1155/2019/9437043.

Saarinen S, Olerup O, Broomé U. Increased frequency of autoimmune diseases in patients with primary sclerosing cholangitis. Am J Gastroenterol. 2000;95(11):3195-9. doi: 10.1111/j.1572-0241.2000.03292.x.

Silveira MG, Mendes FD, Diehl NN, et al. Thyroid dysfunction in primary biliary cirrhosis, primary sclerosing cholangitis and non-alcoholic fatty liver disease. Liver Int. 2009;29(7):1094-100. doi: 10.1111/j.1478-3231.2009.02003.x.

Rachdaoui N, Sarkar DK. Pathophysiology of the Effects of Alcohol Abuse on the Endocrine System. Alcohol Res. 2017;38(2):255-76.

Papineni JK, Pinnelli VBK, Davanum R. Thyroid Hormone Levels in Chronic Alcoholic Liver Disease Patients Before and After Treatment. J Clin Diagn Res. 2017;11(7):BC13-16. doi: 10.7860/JCDR/2017/24552.10276.

Jamil KM, Leedman PJ, Kontorinis N, et al. Interferon-induced thyroid dysfunction in chronic hepatitis C. J Gastroenterol Hepatol. 2009;24(6):1017-23. doi: 10.1111/j.1440-1746.2008.05690.x.

Rashed YK, Khalaf FA, Kotb SE. Thyroid disturbances in children treated with combined pegylated interferon-alpha and ribavirin for chronic hepatitis C. Clin Exp Pediatr. 2020;63(2):52-5. doi: 10.3345/kjp.2018.07150.

Downloads

Published

2024-06-17

Issue

Vol. 62 No. Suplemento 2 (2024): Aniversario del Hospital de Especialidades

Section

Original Articles

License

Copyright (c) 2024 Revista Médica del Instituto Mexicano del Seguro Social

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.