Effect of liver dysfunction on outcome of radioactive iodine therapy for Graves’ disease

Abstract

Liver dysfunction is a common complication of Graves’ disease (GD) that may be caused by excessive thyroid hormone (TH) or anti-thyroid drugs (ATDs). Radioactive iodine (RAI) therapy is one of the first-line treatments for GD, but it is unclear whether it is safe and effective in patients with liver dysfunction. 510 consecutive patients with GD receiving first RAI were enrolled in the study, and followed up at 3-, 6- and 12-month. Liver dysfunction was recorded in 222 (43.5%) patients. GD patients with liver dysfunction had higher serum levels of free triiodothyronine (FT3) (median 27.6 vs. 20.6 pmol/L, p < 0.001) and free thyroxine (FT4) (median 65.4 vs. 53.5 pmol/L, p < 0.001) levels than those with normal liver function. Binary logistic regression analysis showed that duration of disease (OR = 0.951, 95% CI: 0.992–0.980, p = 0.001) and male gender (OR = 1.106, 95% CI: 1.116–2.384; p = 0.011) were significant differential factors for liver dysfunction. Serum TSH levels were higher in patients with liver dysfunction at all 3 follow-up time points (p = 0.014, 0.008, and 0.025 respectively). FT3 level was lower in patients with liver dysfunction at 3-month follow-up (p = 0.047), but the difference disappeared at 6 and 12 months (p = 0.351 and 0.264 respectively). The rate of euthyroidism or hypothyroidism was higher in patients with liver dysfunction than in those with normal liver function at 3 months (74.5% vs 62.5%; p = 0.005) and 6 months (82.1% vs 69.1%; p = 0.002) after RAI treatment, but the difference did not persist at 12-month follow-up (89.6% vs 83.2%, p = 0.081).There were no statistically significant differences in treatment efficacy (94.48% vs 90.31%, p = 0.142), incidence of early-onset hypothyroidism (87.73% vs 83.67%, p = 0.277), and recurrence rate (4.91% vs 7.14%, p = 0.379) between the 2 groups at 12-month follow-up. In conclusion, the efficacy of RAI was comparable in GD patients with liver dysfunction and those with normal liver function.

Hormonal Changes in a Sample of Iraqi Women and their Relationship to Liver Dysfunction

“…In this study, the level of FSH was significantly higher in the patient group as compared to its level in the control group for all groups. It was observed that the levels of the hormone in the (26-35 years old) and (36-45 years old) groups of patients were higher than that in the (15-25 years old) group, as shown in Table (2). In this study, it was observed the level of FSH is affected by aging; the results revealed a significant increase of FSH with the increase of age [16].…”

“…Obesity, diabetes, and even cancer are all increased in risk by liver dysfunction [1]. Several other hormonal illnesses, such as Graves' disease (GD), are associated with liver impairment [2]. Both excess and deficiency of adrenal activity can cause changes in liver function, and adrenocortical dysfunction can occur in cirrhotic individuals, particularly during periods of decompensation.…”

Apathetic Graves’ disease with severe hepatic and renal dysfunction induced by COVID-19 infection: Case report and literature review

“…The patient was initially diagnosed with hyperthyroid-related liver injury complicated by paroxysmal atrial fibrillation. Research [ 17 ] and guidelines [ 2 , 13 , 16 ] suggested that 131 I treatment can be given priority to GD with heart disease and hepatic insufficiency. Research [ 11 ] and guidelines [ 2 ] also recommend long-term drug therapy for patients with senile hyperthyroidism who are unwilling to receive 131 I therapy.…”

Melissa officinalis extract palliates redox imbalance and inflammation associated with hyperthyroidism-induced liver damage by regulating Nrf-2/ Keap-1 gene expression in γ-irradiated rats

“…Moreover, the liver is a major site for the production of albumin, transthyretin and thyroxine-binding globulin proteins that bind thyroid hormones [ 38 ]. Consequently, a hyperthyroid state is associated with various chronic disorders such as cardiovascular diseases, diabetes and liver diseases [ 39 ], and impaired both the hepatic structure and function [ 4 , 40 ]. Additionally, the prevalence of liver dysfunction in patients with hyperthyroidism has been estimated to be between 37% and 77.9% [ 41 ].…”

“…Radioactive iodine and thyroidectomy represent alternative treatments for hyperthyroidism, with a promising prognosis and low relapse rates. However, achieving a balance in the thyroid axis between hyperthyroidism and hypothyroidism can be challenging [ 4 ]. The dysregulation of thyroid hormone production and secretion may lead to an overall increase in metabolism, resulting in a high demand for the synthesis of chemical energy through a series of oxidation-reduction reactions.…”