Incidence of abnormal liver biochemical tests in hyperthyroidism

Abstract

Objective Abnormal serum liver function tests are common in patients with untreated thyrotoxicosis, even prior to the initiation of antithyroidal medications that may worsen their severity. There is a wide range of the incidence of these abnormalities in the published literature. The aim of this study was to assess the risks factors and threshold of thyrotoxicosis severity for developing an abnormal liver biochemical test upon the diagnosis of new thyrotoxicosis. Design Single-institution retrospective cohort study. Patients Patients ≥18 years old receiving medical care at a large, academic, urban U.S. medical center between 2002–2016. Measurements Inclusion criteria were a serum thyroid stimulating hormone [TSH] concentration < 0.3 mIU/L or ICD-9 code for thyrotoxicosis, with thyrotoxicosis confirmed by either a concurrent elevated serum triiodothyronine (T3) and/or thyroxine (T4) concentration [total or free] within 3 months), and an available liver biochemical test(s) within 6 months of thyrotoxicosis. The biochemical liver tests assessed were serum aspartate transaminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (AP), gamma-glutamyltransferase (GGT), total bilirubin, and conjugated bilirubin concentrations. Results In this cohort of 1,514 subjects, the overall incidence of any biochemical liver test abnormality within 6 months of thyrotoxicosis was 39%. An initial serum TSH concentration <0.02 mIU/L, male gender, and African-American race were significant predictors of an abnormal serum liver biochemical test within 6 months of the diagnosis of new-onset untreated thyrotoxicosis. Conclusions This study identifies risk factors for patients who develop an abnormal serum liver biochemical test result within 6 months of a diagnosis of untreated thyrotoxicosis.

Liver enzyme profile and progression in association with thyroid autoimmunity in Graves' disease

“…Abnormal liver enzyme levels are commonly detected at the onset of Graves' disease (GD), with the reported prevalence ranging from 37% to 78% during the acute thyrotoxic phase of the disease . Most of the studies have described alkaline phosphatase (ALP) as the most common liver enzyme elevated, in up to nearly two‐thirds of studied cases . The degree of thyrotoxicosis, age, sex and ethnicity have all been reported to be associated with liver enzyme abnormalities during the acute hyperthyroid state .…”

“…Most of the studies have described alkaline phosphatase (ALP) as the most common liver enzyme elevated, in up to nearly two‐thirds of studied cases . The degree of thyrotoxicosis, age, sex and ethnicity have all been reported to be associated with liver enzyme abnormalities during the acute hyperthyroid state . However, conflicting findings disputing the significance of thyroid hormone levels and liver function abnormality have been reported in similarly large studies .…”

Ophthalmopathy and other influential factors for liver abnormalities in patients with Graves’ disease

“…Since the rst description regarding hepatic dysfunction in patients with hyperthyroidism given by Habershon, the liver function abnormalities or damage seen in patients with hyperthyroidism is widely reported. [5,[9][10][11][12]. It is well known fact that various tissues are affected by elevated thyroid hormones through different mechanisms involving cardiovascular, nervous and gastrointestinal systems.…”

“…[3,4] In the patients of untreated thyrotoxicosis, the reported prevalence of the liver enzyme abnormalities varies widely and ranges from 15-79%. [5] The liver-thyroid interaction is very essential for the maintenance of homeostasis in both the organs. The disorders in any of these organs in uence each other causing clinical and laboratory abnormalities.…”

Perioperative considerations of hyperthyroidism in a patient with liver failure: case report

“…When patients with hyperthyroidism undergo general anesthesia, potential perioperative complications such as atrial fibrillation, congestive heart failure, ischemic heart disease, thrombocytopenia may occur [1,7]. Also, because thyroid hormones are glucuronidated and sulfated within the liver and subsequently excreted into bile, liver dysfunction is commonly observed in patients with thyroid disease [8,9]. This is why all patients with an underlying thyroid condition are recommended to take a preoperative thyroid function test.…”