Download PDF
Horm Metab Res 2015; 47(03): 209-213
DOI: 10.1055/s-0034-1375690
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Risk Factors of Hyperthyroidism with Hepatic Function Injury: A 4-Year Retrospective Study

C. Li
1   Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
,
J. Tan
1   Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
,
G. Zhang
1   Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
,
Z. Meng
1   Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
,
R. Wang
1   Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
,
W. Li
1   Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
,
W. Zheng
1   Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
› Author Affiliations
Further Information

Publication History

received 29 January 2014

accepted 24 April 2014

Publication Date:
27 May 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Hepatic function injury is one of the common complications of hyperthyroidism (mainly Graves’ disease), which affects the choice of treatment and the curative rate. Our goal was to describe clinical and biochemical patterns in patients suffering from Graves’ disease (GD) and hepatic function injury and to determine the influential factors. A cohort of 1 070 patients who received 131I treatment were studied. Many examinations were performed before 131I therapy, such as: the 24-h radioactive iodine uptake of thyroid (RAIU24 h) and serum-free triiodothyronine (FT3), free thyroxine (FT4), sensitive thyroid-stimulating hormone (sTSH), antithyrotrophin receptor antibody (TRAb), thyroglobulin antibody (TgAb), and antithyroid peroxidase antibody (TPOAb), serum hepatic function tests, etc. Data were analyzed by the unpaired t-test, the independent samples t-test, the χ2 test, logistic regression, and Pearson bivariate correlation. Age, course of GD, thyroid’s weight, FT4, TPOAb, and TRAb in GD patients with hepatic function injury were higher than those with normal hepatic function patients. The influential factors were age, hyperthyroidism duration, heart rate, thyroid’s weight, FT4, RAIU24 h, TgAb, TPOAb, and TRAb. RAIU24 h was the protecting factor. Age, course of GD, heart rate, thyroid’s weight, FT4, TRAb, and TPOAb were the risk factors. Patients whose age was higher than 45 years old, heart rate above 90 bpm, thyroid weight more than 35 g, the hyperthyroidism duration more than 3 years, FT4 higher than 70.5 pmol/l, the level of TPOAb above 360 IU/ml, and the level of TRAb above 15 IU/l have increased risk of hepatic function injury. As treatment 131I therapy was found to be the best choice.

Key words

hyperthyroidism - hepatic function injury - radioiodine therapy (131I) - aminotransferase - bilirubin - risk factors
 

  • References

  • 1 de Campos Mazo DF, de Vasconcelos GBS, Pereira MAA, de Mello ES, Bacchella T, Carrilho FJ, Cançado ELR. Clinical spectrum and therapeutic approach to hepatocellular injury in patients with hyperthyroidism. Clin Exp Gastroenterol 2013; 6: 9-17
    PubMedGoogle Scholar
  • 2 Lo CM. Liver transplantation for acute liver failure: Not too early but never too late. Liver Transplant 2008; 14: 1243-1244
    CrossrefPubMedGoogle Scholar
  • 3 Khemichian S, Fong T-L. Hepatic dysfunction in hyperthyroidism. Gastroenterol Hepatol 2011; 7: 337-339
    PubMedGoogle Scholar
  • 4 Upadhyay G, Singh R, Kumar A, Kumar S, Kapoor A, Godbole MM. Severe hyperthyroidism induces mitochondria-mediated apoptosis in rat liver. Hepatology 2004; 39: 1120-1130
    CrossrefPubMedGoogle Scholar
  • 5 Shapiro B. Optimization of radioiodine therapy of thyrotoxicosis: what have we learned after 50 years?. J Nucl Med 1993; 34: 1638-1641
    PubMedGoogle Scholar
  • 6 Leech NJ, Dayan CM. Controversies in the management of Graves’ disease. Clin Endocrinol 1998; 49: 273-280
    CrossrefPubMedGoogle Scholar
  • 7 Nwatsock J, Taieb D, Tessonnier L, Mancini J, Dong-A-Zok F, Mundler O. Radioiodine Thyroid Ablation in Graves’ Hyperthyroidism: Merits and Pitfalls. World J Nucl Med 2012; 11: 7-11
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Abraham P, Avenell A, McGeoch SC, Clark LF, Bevan JS. Antithyroid drug regimen for treating Graves’ hyperthyroidism. Cochrane Database Syst Rev Jan 20 2010; (01) CD003420 DOI: 10.1002/14651858.CD003420.pub4.
    PubMedGoogle Scholar
  • 9 Wolf PL. Biochemical diagnosis of liver disease. Indian J. Clin Biochem 1999; 14: 59-90
    CrossrefPubMedGoogle Scholar
  • 10 Reinhardt MJ, Brink I, Joe AY, von Mallek D, Ezziddin S, Palmedo H, Krause TM. Radioiodine therapy in Graves’ disease based on tissue-absorbed dose calculations: effect of pre-treatment thyroid volume on clinical outcome. Eur J Nucl Med Mol Imag 2002; 29: 1118-1124
    CrossrefPubMedGoogle Scholar
  • 11 Perry R, Hollman A, Wood A, Donaldson M. Ultrasound of the thyroid gland in the newborn: normative data. Arch Dis Childhood Fetal Neonat Ed. 2002. 87. F209-F211
    Google Scholar
  • 12 Malik R, Habib M, Tootle R, Hodgson H. Exogenous thyroid hormone induces liver enlargement, whilst maintaining regenerative potential – a study relevant to donor preconditioning. Am J Transplant 2005; 5: 1801-1807
    CrossrefPubMedGoogle Scholar
  • 13 Malik R, Hodgson H. The relationship between the thyroid gland and the liver. QJM 2002; 95: 559-569
    CrossrefPubMedGoogle Scholar
  • 14 Kibirige D, Kiggundu DS, Sanya R, Mutebi E. Cholestatic hepatic injury due to a thyroid storm: a case report from a resource limited setting. Thyr Res 2012; 5: 6
    PubMedGoogle Scholar
  • 15 de Campos Mazo DF, de Vasconcelos GB, Pereira MA, de Mello ES, Bacchella T, Carrilho FJ, Cancado EL. Clinical spectrum and therapeutic approach to hepatocellular injury in patients with hyperthyroidism. Clin Exp Gastroenterol 2013; 6: 9-17
    PubMedGoogle Scholar
  • 16 Ashkar FS, Miller R, Smoak III WM, Gilson AJ. Liver disease in hyperthyroidism. South Med J 1971; 64: 462-465
    CrossrefPubMedGoogle Scholar
  • 17 Hodgson HJ. The Liver in Systemic Disease. In: Sherlock’s Diseases of the Liver and Biliary System. Dooley JS, Lok A, Burroughs AK, Heathcote J. eds. Wiley-Blackwell; 12th Edition 2011: 615-631
    CrossrefGoogle Scholar
  • 18 Barzilay-Yoseph L, Shabun A, Shilo L, Hadary R, Nabriski D, Kitay-Cohen Y. Thyrotoxic hepatitis. Israel Med Assoc J 2011; 13: 448-450
    PubMedGoogle Scholar
  • 19 Klion F, Segal R, Schaffner F. The effect of altered thyroid function on the ultrastructure of the human liver. Am J Med 1971; 50: 317-324
    CrossrefPubMedGoogle Scholar
  • 20 Kalderon B, Hermesh O, Bar-Tana J. Mitochondrial permeability transition is induced by in vivo thyroid hormone treatment. Endocrinology 1995; 136: 3552-3556
    PubMedGoogle Scholar
  • 21 Venditti P, Di Meo S. Thyroid hormone-induced oxidative stress. Cell Mol Life Sci 2006; 63: 414-434
    CrossrefPubMedGoogle Scholar
  • 22 Xia Y, Qu W, Zhao L-N, Han H, Yang X-F, Sun X-F, Hao L-P, Xu J. Iodine Excess Induces Hepatic Steatosis Through Disturbance of Thyroid Hormone Metabolism Involving Oxidative Stress in BaLB/c Mice. Biol Trace Elem Res 2013; 1-8
    PubMedGoogle Scholar
  • 23 Epstein FH, Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. New Eng J Med 2001; 344: 501-509
    CrossrefPubMedGoogle Scholar
  • 24 Franklyn JA. The Thyroid too much and too little across the ages. The consequences of subclinical thyroid dysfunction. Clin Endocrinol 2013; 78: 1-8
    CrossrefPubMedGoogle Scholar
  • 25 Biondi B, Palmieri EA, Fazio S, Cosco C, Nocera M, Saccà L, Filetti S, Lombardi G, Perticone F. Endogenous Subclinical Hyperthyroidism Affects Quality of Life and Cardiac Morphology and Function in Young and Middle-Aged Patients. J Clin Endocrinol Metab 2000; 85: 4701-4705
    CrossrefPubMedGoogle Scholar
  • 26 Pearce EN, Yang Q, Benjamin EJ, Aragam J, Vasan RS. Thyroid function and left ventricular structure and function in the Framingham Heart Study. Thyroid 2010; 20: 369-373
    CrossrefPubMedGoogle Scholar
  • 27 Ching G, Franklyn J, Stallard T, Daykin J, Sheppard M, Gammage M. Cardiac hypertrophy as a result of long-term thyroxine therapy and thyrotoxicosis. Heart 1996; 75: 363-368
    CrossrefPubMedGoogle Scholar
  • 28 Myers J, Brannon E, Holland B. A correlative study of the cardiac output and the hepatic circulation in hyperthyroidism. J Clin Invest 1950; 29: 1069-1077
    CrossrefPubMedGoogle Scholar
  • 29 Shimizu Y. Liver in systemic disease. World J Gastroenterol 2008; 14: 4111-4119
    CrossrefPubMedGoogle Scholar
  • 30 Polikar R, Burger AG, Scherrer U, Nicod P. The thyroid and the heart. Circulation 1993; 87: 1435-1441
    CrossrefPubMedGoogle Scholar
  • 31 Nygaard B. Hyperthyroidism (primary). Clinl Evid 2008; 3: 611-623
    PubMedGoogle Scholar
  • 32 Bray GA. Increased sensitivity of the thyroid in iodine-depleted rats to the goitrogenic effects of thyrotropin. J Clin Investig 1968; 47: 1640-1647
    CrossrefPubMedGoogle Scholar
  • 33 Zimmermann MB, Ito Y, Hess SY, Fujieda K, Molinari L. High thyroid volume in children with excess dietary iodine intakes. Am J Clin Nutr 2005; 81: 840-844
    PubMedGoogle Scholar
  • 34 Bianchi G, Zoli M, Marchesini G, Volta U, Vecchi F, Iervese T, Bonazzi C, Pisi E. Thyroid gland size and function in patients with cirrhosis of the liver. Liver 1991; 11: 71-77
    PubMedGoogle Scholar
  • 35 Abboud G, Kaplowitz N. Drug-induced liver injury. Drug Safety 2007; 30: 277-294
    CrossrefPubMedGoogle Scholar