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Increased serum reverse triiodothyronine levels at diagnosis of hepatocellular carcinoma in patients with compensated HCV‐related liver cirrhosis
Author(s) -
Sorvillo Francesca,
Mazziotti Gherardo,
Carbone Antonella,
Morisco Filomena,
Cioffi Michele,
Rotondi Mario,
Stornaiuolo Gianfranca,
Amato Giovanni,
Gaeta Giovanni B.,
Caporaso Nicola,
Carella Carlo
Publication year - 2003
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1046/j.1365-2265.2003.01697.x
Subject(s) - cirrhosis , medicine , hepatocellular carcinoma , gastroenterology , euthyroid , liver disease , globulin , triiodothyronine , chronic liver disease , endocrinology , hormone
Summary objectiveT he aim of this study was to investigate changes in thyroid hormone metabolism in relation to the development of hepatocellular carcinoma (HCC) in patients with HCV‐related liver cirrhosis. materials and methods The study group (Group A) comprised 31 patients (25 M, 6 F; median age 62·1 years, range 54·0–81·5 years) affected by HCV‐related liver cirrhosis with superimposed HCC. Acute and chronic systemic disease, other than cirrhosis, inducing ‘euthyroid sick syndrome’ was excluded in all patients. Serum TSH, FT4, FT3, rT3, and thyroxine‐binding globulin (TBG) levels were retrospectively evaluated in frozen aliquots drawn at the time of tumour diagnosis and every 6 months for 3–7 years before HCC diagnosis. The control group (Group B) comprised 29 patients affected by HCV‐related liver cirrhosis without HCC, matched for sex, age and grade of liver dysfunction. results At the time of HCC diagnosis, all patients in Group A were euthyroid with serum TSH, FT4, FT3 and TBG values not significantly different from those of cirrhotic patients of Group B. However, at diagnosis Group A patients had serum rT3 values that were significantly higher than those in Group B (35·0 ng/dl, range 12·0–162·0 vs. 19·0 ng/dl, range 10·0–51·0; Group A vs. Group B; P < 0·001). Serum rT3 values above the normal range were found in 12 patients in Group A (38·7%) but in only one of the patients from Group B (3·4%) (χ 2 10·2; P = 0·001). The serum rT3 levels were not significantly correlated to the Child grade of liver cirrhosis (rho 0·1; P = 0·5). The intrasubject analysis demonstrated that a significant increase in serum rT3 levels occurred at the time of HCC diagnosis but serum FT4, FT3 and TSH values did not change significantly. A receiver operating curve (ROC) demonstrated that a 6‐monthly increase in serum rT3 levels of at least +22·5% identified patients with HCC with a diagnostic accuracy of 81·7% . conclusions O ur study has demonstrated that development of hepatocellular carcinoma is accompanied by a significant increase in serum rT3 levels in patients with low‐grade HCV‐related liver cirrhosis who had no other illness causing the ‘euthyroid sick syndrome’.