Abstract

Background Alcoholic Liver Disease (ALD) is among one of the ten most common causes of deaths worldwide. Liver the largest gland in the body is a major site of thyroid hormones peripheral metabolism and is involved in its conjugation, biliary excretion, oxidative deamination and extrathyroidal deiodination of T4 to T3. In most chronic hepatic illnesses defects arise in thyroid hormone metabolism resulting in sick euthyroid syndrome. The above functions of liver are impaired in chronic liver diseases leading to decrease in T3, T4 and altered TSH levels. Some patients with chronic liver diseases may have thyroiditis, hyperthyroidism or hypothyroidism through autoimmune mechanisms. The exact mechanisms behind this is not well understood and hence the present study. Methods In the present study about 100 males subjects were selected randomly from Medicine OPD of GMCH, Nagpur in the age group of 40 – 60 years (50 normal healthy controls and 50 alcoholics) during May 2020 to May 2022. IEC approval was sought and informed consent was obtained from each subjects. Height, Weight of each subjects were measured by standing against a wall with a measuring scale on it and Body Mass Index (BMI) was calculated and recorded. After satisfying all inclusion and exclusion criterias about 5 ml of venous blood was withdrawn from each subjects ante-cubital vein using disposable sterile syringe and needle under strict aseptic precautions. The samples were immediately processed in ADVIA Centaur XP using chemiluminescence immunoassay technique for T3, T4 and TSH levels. Using appropriate statistical methods (Student’s paired-t-test, Pearson’s correlation coefficient) data was analysed. Results It was observed that BMI in ALD (20.21 ± 2.2) was highly significantly decreased as compared to controls (23.06 ± 2.4) with p – value of < 0.005 [Chart 1.]. In ALD patients there was a highly significant decrease in T3 (0.48 ± 0.08) and T4 (6.4 ± 1.55) levels when compared to controls [T3 (0.98 ± 0.33), T4 (8.85 ± 1.79)] with p – value of < 0.005. While TSH levels (4.77 ± 0.7) in ALD was observed to be highly significantly raised when compared to controls (2.46 ± 0.8) with p – value of < 0.005 [Chart 2.]. Conclusions In ALD patients a highly significant decrease in T3 levels was seen due to decrease peripheral conversion of T4 to T3 may be due to decrease in activity of hepatic iodothyronine – 5’- deiodinase. Moreover, upon withdrawal of ethanol the already decreased TBG reverts back to normal. Acetaldehyde a thyrotoxic agent may cause a blunting TSH response to TRH resulting in altered thyroid hormone levels in ALD patients which may stress a need in better ALD patient management since patients are clinically euthyroid and Propylthiouracil remains the mainstay of treatment in hypothyroidism.

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