Skip to main content
SpringerLink
Log in

The prognostic value of thyroid function tests in predominantly non-alcoholic cirrhotic patients: a prospective investigation

  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

The prognostic value of thyroid function parameters (T3, T4, rT3 and the rT3: T3 ratio) and common liver tests (serum bilirubin, albumin and prothrombin activity) was investigated on hospital admission in 100 consecutive patients with predominantly non-alcoholic liver cirrhosis. Twenty-nine out of 100 patients had a well compensated cirrhosis and their mean values of thyroid tests were similar to those of 40 healthy controls. A low T3 syndrome was found in the remaining 71 decompensated patients. In these thyroid function parameters were correlated with serum bilirubin and prothrombin activity. Moreover mean values of all thyroid and liver tests, except serum albumin, were significantly different between survivors and nonsurvivors at 3 months. To evaluate the best cut-off yalue which allowed to predict the outcome of patients, the Receiver Operating Characteristics (ROC) curves were generated for each test by plotting the values obtained in survivors at 3 months (true positives) vs nonsurvivors (false positives). By holding the false positive errors within 10%, the highest percentage of true positive results (i.e. patients dead at 3 months) was observed for the rT3: T3 ratio, rT3 and serum bilirubin at a cut-off point of 0.841, 55 ng/dl and 3.5 mg/dl, respectively. According to the above cut-offs the rT3: T3 ratio had the best positive predictive value (74%; 95% confidence limits 60–90%) in comparison to rT3 and bilirubin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chopra I.J., Solomon D.H., Chopra U., Young R.T., Chua Teco G.N. Alterations in circulating thyroid hormones and thyrotropin in hepatic cirrhosis: evidence for euthyroidism despite subnormal triiodothyronine. J. Clin. Endocrinol. Metab. 39: 501, 1974.

    Article  CAS  PubMed  Google Scholar 

  2. Nomura S., Pittman C.S., Chambers J.B. jr, Buck M.W., Shimizu T. Reduced peripheral conversion of thyroxine to triiodothyronine in patients with hepatic cirrhosis. J. Clin. Invest. 56: 643, 1975.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Green J.R.B., Snitcher E.J., Mowatt N.A.G., Ekins R.P., Reis L.H., Dawson A.M. Thyroid function and thyroid regulation in euthyroid men with chronic liver disease: evidence of multiple abnormalities. Clin. Endocrinol. (Oxf.) 7: 453, 1977.

    Article  CAS  Google Scholar 

  4. Yamanaka T., Ido K., Kimura K., Saito T. Serum levels of thyroid hormones in liver disease. Clin. Chim. Acta 101: 45, 1980.

    Article  CAS  PubMed  Google Scholar 

  5. Jannì A., D’Azzò G., Craxì A., Marozzi P., Li Puma M., Pinzello G.B. Clinical effects of low T3 on liver function. In: Hesch R.D. (Ed.), The “low T3 syndrome” Academic Press, London and New York, 1981, p. 171.

    Google Scholar 

  6. Israel Y., Walfish P.G., Orrego H., Blake J., Kalant H. Thyroid hormones in alcoholic liver disease. Effect of treatment with 6-n-propylthyouracil. Gastroenterology 76:116, 1979.

    CAS  PubMed  Google Scholar 

  7. Walfish P.G., Orrego H., Israel Y., Blake J., Kalant H. Serum triiodothyronine and other clinical laboratory indices of alcoholic liver diseases. Ann. Intern. Med. 91:13, 1979.

    Article  CAS  PubMed  Google Scholar 

  8. Ködding R., Janzen J., Schmidt E., Hesch R.D. Reverse triiodothyronine in liver disease. Lancet 2: 314, 1976.

    Article  PubMed  Google Scholar 

  9. Hepner G.W., Chopra I.J. Serum thyroid hormone levels in patients with liver disease. Arch. Intern. Med. 139:1117, 1979.

    Article  CAS  PubMed  Google Scholar 

  10. Winkel P., Juhl E., Tygstrup N. and the Copenaghen Study group for liver disease. The prognostic value of clinical and laboratory data in patients with cirrhosis. Scand. J. Gastroenterol. (Suppl. 7) 5: 181, 1970.

    Google Scholar 

  11. Tygstrup N. The prognostic value of laboratory tests in liver disease. Scand. J. Gastroenterol. (Suppl. 19) 8: 47, 1973.

    Google Scholar 

  12. Pagliaro L., Saracci R. Bardelli D., Filippazzo G. and a group of the Italian Association for the study of the liver. Chronic liver disease, alcohol consumption and HBsAg antigen in Italy: a multiregional case-control study. Ital. J. Gastroenterol. 14: 90, 1982.

    Google Scholar 

  13. Swets J.A., Pickett R.M., Whitehead S.F. Assessment of diagnostic technologies. Advanced measurement methods are illustrated in a study of computed tomography of the brain. Science 205: 753, 1979.

    Article  CAS  PubMed  Google Scholar 

  14. Mc Neil B.J., Keeler E., Adelstein S.J. Primer on certain elements of medical decision making. N.Engl. J. Med. 293:211, 1975.

    Article  CAS  Google Scholar 

  15. Oppenheimer J.H., Bernstein G., Surks M.I. Increased thyroxine turnover and thyroidal function after stimulation of hepatocellular binding of thyroxine. J.Clin. Invest. 47:1399, 1968.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Schwartz H.L., Surks M.I., Oppenheimer J.H. Quantitation of extrathyroidal conversion of L-thyroxine to 3, 3′, 5′-L-triiodothyronine in the rat. J.Clin. Invest. 50:1124, 1971.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Pittman C.S., Chambers J.B. jr., Read V.H. The extrathyroidal conversion rate of thyroxine to triiodothyronine in normal man. J.Clin. Invest. 50: 1187, 1971.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Hesch R.D., Brunner G., Söling H.D. Conversion of thyroxine (T4) and triiodothyronine (T3) and the subcellular localization of the converting enzyme. Clin. Chim. Acta 59: 209, 1975.

    Article  CAS  PubMed  Google Scholar 

  19. Visser T.J., Van Der Does Tobe I., Docter R., Henneman G. Conversion of thyroxine into triiodothyronine by rat liver homogenate. Biochem. J. 750:489, 1975.

    Google Scholar 

  20. Chopra I.J. An assessment of daily production and significance of thyroidal secretion of 3, 3′, 5′ triiodothyronine (reverse T3) in man. J.Clin. Invest. 58: 32, 1976.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Marozzi P., D’Azzò G., Li Puma M., Ficola U., Janni A., Greco J. The behaviour of thyroid hormones in liver cirrhosis. In: Ekins R., Faglia G., Pennisi F., Pinchera A. (Eds.), Free thyroid hormones. Excerpta Medica, Amsterdam, 1978, p. 286 (abs).

    Google Scholar 

  22. Hepner G.W., Vesell E.S. Quantitative assessment of hepatic function by breath analysis after oral administration of 14C-aminopyrine. Ann. Intern. Med. 83: 632, 1975.

    Article  CAS  PubMed  Google Scholar 

  23. Slag M.F., Morley J.E., Elson M.K., Crowson T.W., Nuttall F.R., Shafer R.B. Hypothyroxinemia in critically ill patients as a predictor of high mortality. J.A.M.A. 245:43, 1981.

    Article  CAS  PubMed  Google Scholar 

  24. Kaptein E.M., Grieb D.A., Spencer C.A., Wheeler W.S., Nicoloff J.T. Thyroxine metabolism in the low T4 state of critical nonthyroidal illness. J. Clin. Endocrinol. Metab. 53: 764, 1981.

    Article  CAS  PubMed  Google Scholar 

  25. Kaptein E.M., Weiner J.M., Robinson W.J., Wheeler W.S., Nicoloff J.T. Relationship of altered thyroid hormone indices to survival in nonthyroidal illnesses. Clin. Endocrinol. (Oxf.) 16: 565, 1982.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Istituto di Endocrinologia, University of Palermo, Divisione di Endocrinologia, Ospedale V. Cervello, via Tra.bucco 180, 90100, Palermo, Italy

    Girolamo D’Azzò M.D., P. Garofalo & A. Jannì

  2. Istituto di Clinica Medica R, University of Palermo, Divisione di Medicina Interna, Ospedale V. Cervello, 90100, Palermo, Italy

    G. B. Pinzello, F. Pace & A. Craxì

Authors
  1. Girolamo D’Azzò M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. B. Pinzello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Pace
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Garofalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Craxì
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Jannì
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

D’Azzò, G., Pinzello, G.B., Pace, F. et al. The prognostic value of thyroid function tests in predominantly non-alcoholic cirrhotic patients: a prospective investigation. J Endocrinol Invest 8, 331–336 (1985). https://doi.org/10.1007/BF03348508

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03348508

Key-words

Search

Navigation