The abnormality of thyroid hormones in patients with type A hepatic encephalopathy
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Lin Wang1, Wanyou Yu2, Wukui Cao2 and Wei Lu2
1Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center of Digestive Diseases, Beijing, China
2Department of ICU, Tianjin City Second People’s Hospital, Tianjin, China
Lin Wang, email: [email protected]
Keywords: hepatic encephalopathy, acute liver failure, thyroid hormones, low TSH, inpatient survival
Received: January 17, 2017 Accepted: June 02, 2017 Published: June 29, 2017
Abnormality of thyroid hormones in liver diseases is common, but data is lacking in patients with type A hepatic encephalopathy (HE). The present study was aimed to determine whether there was an abnormality in thyroid hormones among patients with type A HE. We measured the levels of thyroid hormones in 36 acute liver failure (ALF) patients with type A HE and in 29 acute liver injury patients (international normalized ratio, INR ≥ 1.5) without encephalopathy as control. The clinical parameters associated with abnormality of thyroid hormones were evaluated. ALF patients with type A HE exhibited decreased TSH levels compared to patients without encephalopathy (0.17 vs 1.08 μIU/mL, P < 0.001). There was no difference in T3 and T4 levels (both total and free) between the two groups. The logistic regression analysis identified type A HE as an independent related factor for the occurrence of low TSH (Odds Ratio = 12.32) in patients with ALF. Correlation analysis showed that there was an inverse correlation between TSH level and the grade of encephalopathy (r = -0.795). Furthermore, patients with low TSH depicted poor survival rate than those with normal TSH level (29.3% vs 44.1%, P = 0.003). Patients with type A HE exhibited subclinical central hypothyroidism, and had significant decreased TSH level, which had inverse correlation with the grade of encephalopathy. The reduced TSH was associated with poor survival rate.
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