triiodothyronine--reverse and Hepatitis

Modern day evaluation of thyroid disorders requires a combination of accurate clinical judgement and reliable, sensitive, and specific thyroid functions tests. Principle among the latter are thyroxine (T4) 3, 5, 3'-triiodothyronine (T3), and thyroid-stimulating hormone (TSH). Also playing an important role in special situations are free thyroxine, an assessment of bound and unbound thyroid-binding globulin, TRH stimulation, long-acting thyroid stimulator (LATS), antibodies to thyroid hormone and to thyroid receptors. Basic to interpretation of these tests in the clinical setting is a comprehension of the relationship of the hypothalamus, the pituitary, and the thyroid gland as well as a knowledge of the peripheral metabolism of thyroxine and triiodothyronine. The role of each of these laboratory tests in the evaluation of hyper- and hypometabolic states, their alteration in nonthyroid and other endocrine disorders, and the effects of environmental and physiological factors on these tests are reviewed.

Topics: Adult; Aged; Autoantibodies; Calcitonin; Choriocarcinoma; Female; Fetus; Hepatitis; Humans; Hyperthyroidism; Hypothalamo-Hypophyseal System; Hypothyroidism; Infant, Newborn; Kidney Diseases; Male; Mental Disorders; Middle Aged; Pregnancy; Stress, Physiological; Thyroglobulin; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse

To evaluate thyroid function in 19 patients with fulminant hepatitis (FH), we have measured total and free 3,5,3'-triiodothyronine (T3) and thyroxine (T4), 3,3',5'-triiodothyronine (reverse T3, rT3), thyroid-stimulating hormone (TSH) and thyroxin-binding globulin (TBG) in patients with FH, compared with those of 80 patients with other various liver diseases and of 10 healthy controls. Patients with FH showed the lowest values of serum T3 and the highest levels of rT3 among all patients with liver diseases studied. Furthermore, patients with FH showed a significant increase of rT3 in comparison with subacute hepatitis (SAH), "acute-on-chronic" (AOC) type of hepatic failure, ordinary and severe forms of acute hepatitis (AHo and AHs) and decompensated liver cirrhosis (LC-D). In addition, serum T3 and rT3 and the rT3/T3 ratio significantly correlated with prothrombin time (PT) and plasma methionine level. We also found that serum T3 and rT3 concentrations and the rT3/T3 ratio showed early and rapid normalization in cases of FH that survived, but they did not improve in patients with fatal outcome. These results suggest that serum T3, particularly rT3 concentrations and the rT3/T3 ratio may be useful indicators for assessing the severity and prognosis of patients with FH and can be considered to the sensitive indices for functioning hepatic microsomal reserve as well.

Topics: Adult; Aged; Female; Hepatic Encephalopathy; Hepatitis; Humans; Male; Methionine; Middle Aged; Prognosis; Prothrombin Time; Thyroid Hormones; Thyrotropin; Thyroxine; Thyroxine-Binding Proteins; Triiodothyronine; Triiodothyronine, Reverse

Concentrations of thyroid hormones and thyrotropin (TSH) were measured in sera of clinically euthyroid patients with various liver diseases and compared with normal controls. The mean serum concentration of 3,3',5'-triiodothyronine (reverse T3, rT3) was significantly increased in patients with decompensated liver cirrhosis (p less than 0.01). This increase seemed to be dependent upon the hepatic damage, although it was not significant in patients with acute hepatitis, chronic hepatitis and compensated liver cirrhosis. The mean serum concentration of 3,3',5-triiodothyronine (T3) was significantly decreased in patients with decompensated liver cirrhosis (p less than 0.05). However, in patients with acute hepatitis, chronic hepatitis and compensated liver cirrhosis, the mean concentration of T3 was above the normal. The mean value of rT3/T3 ratios in patients with acute hepatitis, chronic hepatitis and compensated liver cirrhosis were similar to that of normal controls, but in patients with decompensated liver cirrhosis, the mean value of rT3/T3 ratios was markedly higher than that of normal controls. The rT3/T3 ratios have little or no correlation with some standard liver function tests. These results suggest that marked alterations of peripheral conversion of thyroxine (T4) to rT3 or T3 may be found only in a state of decompensated liver cirrhosis among the various liver diseases.

Topics: Acute Disease; Adolescent; Adult; Aged; Chronic Disease; Hepatitis; Humans; Liver Cirrhosis; Liver Function Tests; Thyroid Hormones; Thyrotropin; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse

Levels of serum triiodothyronine (T3), reverse triiodothyronine (rT3), and thyroxine (T4) were determined in 29 patients with alcoholic cirrhosis, seven patients with acute hepatitis, and 14 control patients hospitalized for chronic disease. Serum T3 levels were decreased significantly and serum rT3 levels increased significantly in the patients with alcoholic cirrhosis. Serum T3 and T4 levels were lower and rT3 levels higher in the cirrhotic patients who died within three months of the study compared with those who survived. A combination of prothrombin time, aminopyrine breath test results, and rT3 and T3 determinations gave significant predictive information about survival in patients with cirrhosis. The data suggest that assay of serum thyroid hormone levels together with prothrombin time and the aminopyrine breath test may be helpful in assessing the course and prognosis of patients with liver disease.

Topics: Adult; Aged; Breath Tests; Hepatitis; Humans; Liver Cirrhosis, Alcoholic; Liver Diseases; Middle Aged; Prognosis; Prothrombin Time; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse

Topics: Chronic Disease; Hepatitis; Humans; Liver Cirrhosis; Liver Neoplasms; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse