Thyroid Function Abnormalities in Chronic Liver Disease

Abstract

Background: Chronic liver disease alters several endocrine pathways, and the thyroid-liver relationship is clinically relevant because the liver contributes to thyroid hormone binding, conversion, conjugation, and clearance. Mild thyroid dysfunction may remain clinically silent in cirrhosis, yet it may carry information about hepatic reserve. Objectives: To assess thyroid function abnormalities in subjects with chronic liver disease and to determine their association with severity of liver disease assessed by Child-Pugh class and CLD stage. Methods: This prospective observational study was conducted in the Department of General Medicine, K.C. General Hospital, Bangalore, Karnataka, for a period of 9 months. A total of 130 subjects aged 18-60 years with chronic liver disease were evaluated. Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were assessed using a chemiluminescence assay. Liver disease severity was graded using Child-Pugh class. Categorical associations were tested using the chi-square test, with p<0.05 considered statistically significant. Results: The mean age was 45.24±9.88 years, with a range of 24-59 years. Males constituted 94 (72.3%) subjects. Child-Pugh class A, B, and C accounted for 41 (31.5%), 56 (43.1%), and 33 (25.4%) subjects, respectively; 89 (68.5%) belonged to CLD stage 2. Thyroid function was normal in 85 (65.4%) subjects, whereas 39 (30.0%) showed a hypothyroid biochemical pattern and 6 (4.6%) showed a hyperthyroid biochemical pattern. Hypothyroid-pattern dysfunction was concentrated in advanced disease: 21/39 (53.8%) were in Child-Pugh class C and 36/39 (92.3%) were in CLD stage 2. The association between thyroid functional status and Child-Pugh class, as well as CLD stage, was statistically significant (chi-square test, p<0.001). Low FT3 was observed in 35 (26.9%) subjects and showed a significant association with Child-Pugh class and CLD stage (p<0.001). Conclusion: Biochemical thyroid dysfunction was frequent in chronic liver disease despite clinical euthyroidism. Hypothyroid-pattern abnormalities, particularly low FT3, increased with advancing Child-Pugh severity. Routine thyroid profiling may therefore add useful biochemical context while assessing hospitalized patients with chronic liver disease.