Clinical associations between thyroid and liver diseases
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Abstract The liver has an important role in thyroid hormone metabolism and the level of thyroid hormones is also important to normal hepatic function and bilirubin metabolism. Besides the associations between thyroid and liver diseases of an autoimmune nature, such as that between primary biliary cirrhosis and hypothyroidism, thyroid diseases are frequently associated with liver injuries or biochemical test abnormalities. For example, thyroid diseases may be associated with elevation of alanine aminotransferase and alkaline phosphatase, which is mainly of bone origin, in hyperthyroidism and aspartate aminotransferase in hypothyroidism. Liver diseases are also frequently associated with thyroid test abnormalities or dysfunctions, particularly elevation of thyroxine‐binding globulin and thyroxine. Hepatitis C virus infection has been connected with thyroid abnormalities. In addition, antithyroid drug therapy may result in hepatitis, cholestasis or transient subclinical hepatotoxicity, whereas interferon (IFN) therapy in liver diseases may also induce thyroid dysfunctions. These thyroid‐liver associations may cause diagnostic confusions. Neglect of these facts may result in over or under diagnosis of associated liver or thyroid diseases and thereby cause errors in patient care. It is suggested to measure free thyroxine (FT4) and thyroid‐stimulating hormone (TSH) which are usually normal in euthyroid patients with liver disease, to rule out or rule in coexistent thyroid dysfunctions, and consider the possibility of thyroid dysfunctions in any patients with unexplained liver biochemical test abnormalities. It is also advisable to monitor patients with autoimmune liver disease or those receiving IFN therapy for the development of thyroid dysfunctions, and patients receiving antithyroid therapy for the development of hepatic injuries.
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Hyperthyroidism can itself cause mildly abnormal liver function tests in up to 30% of patients.
“Hyperthyroidism can itself cause mildly abnormal liver function tests in up to 30% of patients (149).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [149]
Low white blood cell counts are common in patients with Graves' disease and in African Americans, 10% of whom have a neutrophil count under 2000, and abnormal liver enzymes are frequently seen in patients with thyrotoxicosis.
“This suggestion is made in part because low WBC counts are common in patients with GD and in African Americans [10% of whom have a neutrophil count under 2000 (148)], and abnormal liver enzymes are frequently seen in patients with thyrotoxicosis (149).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [149]
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- Authors
- HUANG, M., & LIAW, Y.
- Affiliations
- Chang Gung Memorial Hospital (TW)
- Corresponding author
- LIAW, YUN‐FAN
- ORCID
- LIAW, YUN‐FAN
- Venue
- Journal of Gastroenterology and Hepatology
- Publisher
- Wiley
- Published
- 1995-06
- Volume
- 10
- Issue
- 3
- Pages
- 344-350
- ISSN
- 0815-9319 (ISSN-L)
- 1440-1746
- OpenAlex
- W2084763031
- Cited by
- 186
- References
- 80
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 9 · 2021: 13 · 2020: 16 · 2019: 11 · 2018: 13 · 2017: 9 · 2016: 7 · 2015: 7 · 2014: 9 · 2013: 9 · 2012: 8
- FWCI
- 0.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- thyroid dysfunction, liver disease, autoimmune liver disease, primary biliary cirrhosis, hypothyroidism, hyperthyroidism, liver enzymes, alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, thyroxine-binding globulin, hepatitis C virus, cholestasis, interferon therapy, free thyroxine, thyroid-stimulating hormone, diagnostic confusion
- MeSH terms
- Humans, Hyperthyroidism, Hypothyroidism, Interferons, Liver, Liver Diseases, Thyroid Diseases, Thyroid Gland
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