Low Serum Free Triiodothyronine Is Associated with Increased Risk of Decompensation and Hepatocellular Carcinoma Development in Patients with Liver Cirrhosis

Abstract

Background: FT3 levels in plasma may provide a marker for liver status in cirrhosis. Aim: The aim is to correlate thyroid functions with hepatic status in compensated and decompensated cirrhosis, and to study their effect on development of HCC. Settings and Design: Prospective controlled cohort study. A total of 58 patients with liver cirrhosis were recruited from Kasr AlAiny ER and outpatient clinics. Patients were categorised into compensated (11), decompensated (39) and patients with hepatocellular carcinoma (8). The study also included 12 healthy controls. Methods and Material: Liver function tests, TSH, FT4 and FT3 and abdominal ultrasound and triphasic computed tomography abdominal scans were done. Statistical Analysis Used: Chi-square and unpaired t-tests were used for comparison. One way ANOVA and Kruskal Wallis tests were used to compare more than two groups. Spearman Correlation followed by logistic regression analysis of significant variables was used to find predictors of dependent variables. Results: The frequency of patients with low FT3 was significantly higher in patients with liver cirrhosis (48%), and HCC (50%) than control subjects (12%) (p-value < 0.001). Mean serum FT3 was lowest among decompensated patients (2 pg/ml ± 0.7), followed by patients with HCC (2.5 pg/ml ± 0.7) and highest among compensated patients (3.7 pg/ml ± 0.4), p-value < 0.001. Logistic regression analysis showed that low FT3, male gender, ulcer bleeding and encephalopathy were independently associated with the development of HCC (OR, 95% CI: 1.1, 0.3 - 8). Conclusions: Low FT3 is common among patients with decompensated liver cirrhosis and HCC. FT3 shows a significant negative correlation with severity of liver disease and deterioration of liver function. Low FT3 shows a significant independent association with HCC.