hormones are essential for proper functioning of body cells and in condition of
hypothyroidism the levels of triiodothyronine and thyroxine are decreased also
affecting liver cells along with other systems of body. Levothyroxine is given
to treat hypothyroidism, which control the levels of thyroid hormone in
patients and also decrease augmented levels of liver aminotransferases (Christ-Crain Mirjam et
al., in 2004).
our study the patients of hypothyroidism were given levothyroxine and their
thyroid and liver profiles were compared with healthy control. The means and
standard error of means of control and hypothyroid patients for fT4 were 16.62
± 0.72 and 14.16 ± 2.34; for fT3: 4.73 ± 0.15 and 2.81 ± 0.5;
for TSH: 3.07 ± 0.18 and 16.65 ± 6.06; for ALT: 32.5
± 2.24 and 26.79 ± 2.51; and for AST: 42.25 ± 1.84 and 62.79 ±
The p-values with use of levothyroxine for fT4, fT3, TSH, ALT and
AST were 0.333, 0.002, 0.043, 0.103 and 0.006 respectively. P-values less than
0.05 were taken significant while values above 0.05 were considered
non-significant. fT3, TSH and AST were proved to be significant and only fT4
and ALT were found non-significant. Raised levels of AST reveal that altered
thyroid state in hypothyroidism causes liver dysfunction, so, liver function
tests should be monitored in thyroid dysfunction, more considerably in
hypothyroidism (Ajayi AF and Akhigbe RE, 2012). The
insignificancy of fT4 and ALT provide evidence of efficacy of levothyroxine
only for fT4 and ALT in our population. Moreover, reversal of abnormal ALT can
readily be seen during normalization of altered fT4.
levels of thyroid hormones perturb the levels of liver enzymes as observed in
many studies. Michaela Biscoveanu and Hasinski S. in
2000 conducted a study to find out the frequency of liver dysfunction in
patients with hyperthyroidism. They concluded that abnormal LFT’s in
hyperthyroid patients is common and this makes the diagnosis of liver disease
hard until euthyroid state has achieved (Michaela Biscoveanu and Hasinski S.
2000). By employing anti-thyroid drugs thyroid hormones come to their
standard levels and sometime surgery becomes obligatory. Two drugs were
exploited in our study i.e., carbimazole and propylthiouracil for restoring
means and standard error of means for control population for fT4 were: 16.62 ± 0.72; for fT3: 4.73
± 0.15; for TSH: 3.07 ± 0.18; for ALT: 32.5 ± 2.24, and, for AST: 42.25
± 1.84 respectively. In study group of hyperthyroid patients on
carbimazole therapy the means and standard error of means of parameters i.e.,
fT4, fT3, TSH, ALT and AST were 39.61 ± 19.52,
7.21 ± 0.94, 6.26 ± 2.20,
22.79 ± 3.14 and 47.64 ± 5.35 respectively; while with propylthiouracil therapy,
these values were 27.45 ± 9.96, 9.53 ± 4.97, 1.99 ± 0.67, 16.5 ± 4.25 and
32 ± 4.81 respectively.
All parameters were found non- significant in
hyperthyroidism with both drugs when statistically analyzed with control group.
Same results were reported in district Hazara, Khyber Pakhtunkhwa, Pakistan by Khan T.M et al., in 2010 where insignificant
relation was found between plasma thyroid hormones and liver enzymes (Khan T.M
et al., 2010). In our study, the p-values for fT4, fT3, TSH, ALT and AST
were 0.708, 0.136, 0.520, 0.078 and 0.504 respectively. This statistical
analysis suggests that the antithyroid drugs i.e. carbimazole and
propylthiouracil have a strong effect in normalizing raised levels of thyroid
hormones as well as blatantly reverse abnormal levels of ALT and AST (Hitoshi Ichikawa et al., 2009). Previous studies have proved the
capability of antithyroid drugs in restoring euthyroid status and normalizing
abnormal thyroid levels. A case study
was conducted by E. Tzemanakis et al in 2000 in which a patient suffering from
hyperthyroidism developed acute icteric hepatitis. The patient showed an
increased level of ALT and AST and all the conditions of hepatitis were
reversed as far as antithyroid drug was started (E. Tzemanakis et al., 2000).
Similarly, a study was conducted by Leeuwenburgh et al., 2001 in which a
15-year-old boy was brought with hyperthyroidism with associated biological and
histological hepatic aberrations. He was undergone with antithyroid therapy and
after therapy with antithyroid agents not only the hyperthyroidism reversed but
also the hepatic profile were stabilized (Leeuwenburgh et al., 2001).
and propylthiouracil successfully normalize the biochemical parameters fT4,
fT3, TSH, ALT and AST while levothyroxine fail to normalize the levels of fT3,
TSH and AST. So, we recommend the use of combinational therapy along with
levothyroxine in hypothyroid patients in order to control disturbed levels of
thyroid hormones and better performance of the liver. Furthermore, liver
function tests should also performed in thyroid patients in order to check any
abnormality in liver function as a result of thyroid disorder.
would like to acknowledge Center of Nuclear Medicine, Mayo Hospital Lahore for
their tremendous support in this project and we are also grateful to Miss
Rabail Alam for statistical analysis of the study.
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