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The interplay between thyroid and liver: implications for clinical practice

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Abstract

A complex relationship exists between thyroid and liver in health and disease. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism. Conversely, thyroid hormones affect activities of hepatocytes and hepatic metabolism. Serum liver enzyme abnormalities observed in hypothyroidism may be related to impaired lipid metabolism, hepatic steatosis or hypothyroidism-induced myopathy. Severe hypothyroidism may have biochemical and clinical features, such as hyperammonemia and ascites, mimicking those of liver failure. Liver function tests are frequently abnormal also in hyperthyroidism, due to oxidative stress, cholestasis, or enhanced osteoblastic activity. Antithyroid drug-associated hepatotoxicity is a rare event, likely related mainly to an idiosyncratic mechanism, ranging from a mild hepatocellular damage to liver failure. Propylthiouracil-induced liver damage is usually more severe than that caused by methimazole. On the other hand, thyroid abnormalities can be found in liver diseases, such as chronic hepatitis C, liver cirrhosis, hepatocellular carcinoma, and cholangiocarcinoma. In particular, autoimmune thyroid diseases are frequently found in patients with hepatitis C virus infection. These patients, especially if thyroid autoimmunity preexists, are at risk of hypothyroidism or, less frequently, thyrotoxicosis, during and after treatment with interpheron-alpha alone or in combination with ribavirin, commonly used before the introduction of new antiviral drugs. The present review summarizes both liver abnormalities related to thyroid disorders and their treatment, and thyroid abnormalities related to liver diseases and their treatment.

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Abbreviations

A:

Albumin

AbTg:

Anti-thyroglobulin antibodies

AbTPO:

Anti-thyroid peroxidase antibodies

AITD:

Autoimmune thyroid diseases

ALP:

Alkaline phosphatase

ALT:

Alanino amino transferase

AST:

Aspartate amino transferase

ATDs:

Antithyroid drugs

CCA:

Cholangiocarcinoma

DAAs:

Direct-acting antiviral

DTC:

Differentiated thyroid carcinoma

GGT:

Gamma glutamyl transferase

GT:

Genotype

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

IFN:

Interferon

LDH:

Lactate dehydrogenasis

MMI:

Methimazole

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

PEG:

Polyethylene glycol

PTU:

Propylthiouracil

RAI:

Radioiodine

RFA:

Radiofrequency ablation

SVR:

Sustained virologic response

TACE:

Transarterial chemoembolization

TBG:

Thyroxine-binding globulin

Tg:

Thyroglobulin

TNF-α:

Tumor necrosis factor alpha

TPO:

Thyroid peroxidase

TSH:

Thyroid-stimulating hormone or thyrotropin

TTR:

Transthyretin

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Acknowledgements

This work was partly supported by grants from the Ministry of Education, University and Research (MIUR, Roma) to LB and from the University of Insubria to LB and EP. DG was supported by a University of Insubria Ph.D. scholarship.

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  1. Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy

    E. Piantanida, S. Ippolito, D. Gallo, E. Masiello, P. Premoli, C. Cusini, S. Rosetti, J. Sabatino, L. Bartalena & M. L. Tanda

  2. Gastroenterology and Gastrointestinal Endoscopic Unit, Department of Specialistic Medicine, ASST Dei Sette Laghi, Varese, Italy

    S. Segato

  3. Accademia Peloritana Dei Pericolanti, University of Messina, Messina, Italy

    F. Trimarchi

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Piantanida, E., Ippolito, S., Gallo, D. et al. The interplay between thyroid and liver: implications for clinical practice. J Endocrinol Invest 43, 885–899 (2020). https://doi.org/10.1007/s40618-020-01208-6

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