THYROID-FUNCTION IN PATIENTS WITH ALCOHOLIC CIRRHOSIS

Abstract

Total serum thyroxine (T4), total serum triiodothyronine (T3), thyrotropin (TSH) and TRH [thyroliberin] induced TSH release were measured in 50 clinically euthyroid men with alcoholic cirrhosis and compared to 20 age matched control men to determine the thyroid status in cirrhosis. Free serum T4 (FT4), free T3 (FT3) and reverse T3 (rT3), were measured in 34 patients. In these patients, a clinical and biological index was devised to score the severity of the disease. T4-binding-globulin (TBG) levels were measured in 20 patients. In cirrhotics, the mean total T4 level is normal but the mean T3 level is markedly reduced; FT4 is slightly raised and FT3 is decreased. Serum rT3 levels are often very high and correlated to T3. Basal TSH concentrations were slightly significantly higher than normal; the mean magnitude of TSH responses to TRH is comparable to controls but the individual responses are very variable, insufficient or exaggerated, and not correlated with other thyroid function tests. The mean TBG level is also normal and not correlated with total free thyroid hormones. Correlation of thyroid function tests with liver function showed significant correlations between T3, FT3, rT3 or TSH and serum albumin concentration and particularly between T3, rT3 and the clinical and biological index. So the ratio rT3/T3 may be proposed as a valuable index of prognosis and severity of the disease. In alcoholic cirrhosis, thyroid function and regulation are characterized by normal T4 and low T3 levels related to reduced extrathyroidal T4 to T3 conversion with accumulation of rT3, by increased FT4 and decreased FT3 without change in TBG levels.sbd.and thus maintenance of the euthyroid state.sbd.and by a hypothalmo-pituitary dysfunction. These alterations are related to the degree of liver dysfunction.