PREVALENCE OF THYROID DYSFUNCTION IN PATIENTS OF CIRRHOSIS OF LIVER AND ITS CORRELATION WITH SEVERITY OF CIRRHOSIS

Introduction: Abnormalities in thyroid hormones level have been observed commonly in patients of cirrhosis. Aim: To determine the prevalence of thyroid dysfunction in liver Cirrhosis and its correlation with severity of cirrhosis Materials and Methods: Early morning fasting serum thyroid stimulating hormone (TSH), serum thyroxine (T4) and serum triiodothyronine (T3) were measured by radioimmunoassay in 50 consecutive patients with liver cirrhosis (irrespective of etiology) who did not have prior history of thyroid disease. Patients with known thyroid disease, patients who had any previous thyroid surgery or exposure to radioactive iodine in past were excluded from this study. The age range of our study population was 27-80 years with mean age being 47.82 years. Out of the 50 patients, 35 were males (70%) and 15 were females (30%) with male to female ratio of 2.33. Twenty one patients had alcoholic liver disease, 20 had Hepatitis C, 5 had hepatitis B and 4 patients had cryptogenic cirrhosis. Severity of cirrhosis was categorized by using Child-Turcott-Pugh (CTP) criteria. On assessment of severity of cirrhosis 26 patients belonged to CTP A, 19 to CTP B and 5 to CTP C. Results: Subclinical hypothyroidism was seen in 5 out of 50 patients (10 %) and hyperthyroidism was observed in 2 cases (4%). Of the 5 patients having hypothyroidism, 2 belonged to CTP A (out of 26 i.e 7.69%), 1 belonged to CTP B (out of 19 i.e 5.26 %), and 2 belonged to CTP C (out of 5 i.e 40%). Among the patients with hypothyroidism, 3 (60%) had ethanol related liver cirrhosis, 1 (20%) had Hepatitis C whereas 1 had cryptogenic cirrhosis (20%). On the other hand 3 out of 21 patients (14.28%) with ethanol related liver cirrhosis, 1 out of 20 patients (5%) with Hepatitis C related liver cirrhosis and 1 out of 4 patients (25%) with cryptogenic cirrhosis had hypothyroidism. Two Patients with hyperthyroidism belonged to CTP A; one had cryptogenic cirrhosis and one has hepatitis C. Conclusion: High incidence of abnormalities in circulating thyroid hormone concentrations i.e hypothyroidism is noted especially in those with ethanol related liver cirrhosis and it is associated with more advanced liver disease (p= 0.02) Abbreviations: CTP-Child Turcott Pugh, TSH- Thyroid Stimulating Hormone.