9–11 Mechanistically, some researchers have suggested that excess triiodothyronine (T3) causes hepatic dysfunction by inducing apoptosis via activation of a mitochondrial-dependent pathway, and that this hyperthyroidism-induced apoptosis activates death receptor-mediated pathways. 3–8 There are several aspects contributing to hepatic dysfunction in the setting of hyperthyroidism, among them, a wide spectrum has been attributed to hyperthyroidism alone. However, the reported prevalence varies between different studies, ranging from 37% to 78%. 2 Clinically, it is not uncommon to observe liver function test (LFT) abnormalities in patients with untreated hyperthyroidism. 1 Graves’ disease (GD) is the most common cause of hyperthyroidism, and accounts for as many as 50–80% of cases of hyperthyroidism in different regions of the world. Hyperthyroidism is a subcategory of thyrotoxicosis, occurs in approximately 2% of women and 0.2% of men worldwide, and can affect multiple organ systems including the cardiovascular, gastrointestinal and hepatic systems. The optimal cutoffs for FT4 and TRAb to predict abnormal LFTs were 75 pmol/L and 15 IU/L, respectively, based on ROC analysis. Binary logistic regression analysis identified higher FT4 concentration (odds ratio : 1.017, 95% confidence interval : 1.005–1.030, P = 0.006) and higher TRAb value (OR: 1.038, 95% CI:1.013–1.064, P = 0.003) to be independent risk factors predicting abnormal LFTs. In the univariate analysis, patients in group A had significantly higher FT3 concentration (37.5 vs 33.4 pmol/L, P = 0.009), FT4 concentration (85.7 vs 77.4 pmol/L, P = 0.002) and TRAb level (22.2 vs 17.4 IU/L, P < 0.001) when compared with those in group B. A receiver operating characteristic (ROC) curve was also plotted to verify the accuracy of predictors. Logistic regression analysis was used to determine predictive factors contributing to abnormal LFTs. Among them, the frequencies of ALT, AST, ALP, γ-GTP, TBIL and DBIL abnormalities were 52.7%, 32.2%, 45.9%, 38.5%, 23.4%, 2.9%, respectively, and the number of patients with 1 to 6 hepatic variable abnormalities were 89, 64, 30, 16, 6 and 0, respectively.
In total, 205 (70.9%) cases were found to have at least 1 LFT abnormality. All patients were divided into abnormal LFTs (group A) and normal LFTs (group B). This was a retrospective study of 289 consecutive cases of newly diagnosed and untreated patients with GD.
The aim of this study was to explore factors predicting abnormal LFTs induced by GD alone. To date, there are limited data demonstrating the factors or biochemical indexes contributing to LFT abnormalities in this patient population. Ībnormal liver function tests (LFTs) are often observed in patients with Graves’ disease (GD).
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24, Fukang Road, Nankai District, Tianjin 300192, China (e-mail: ).Ībbreviations: γ-GTP = gammaglutamyl transpeptidase, ALP = alkaline phosphatase, ALT = alanine aminotransferase, anti-Tg = thyroglobulin antibody, anti-TPO = thyroid peroxidase antibody, AST = aspartate aminotransferase, AUC = area under curve, BMI = body mass index, BW = body weight, CI = confidence interval, DBIL = direct bilirubin, FT3 = free triiodothyronine, FT4 = free thyroxine, GD = Graves’ disease, LFT = liver function test, OR = odds ratio, RAIU = radioiodine uptake, ROC = receiver operating characteristic, TBIL = total bilirubin, TRAb = thyrotropin receptor antibodies. From the Department of Nuclear Medicine, Tianjin First Central Hospital (RGZ, LQ, JQW, JS) Department of Pathology, Research Institute of Liver Diseases, Tianjin Second People's Hospital, Tianjin (XT) and Department of Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China (XEW).Ĭorrespondence: Ruiguo Zhang, Department of Nuclear Medicine, Tianjin First Central Hospital, No.
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