THYROID-FUNCTION AND SERUM IGF-1 IN CHILDREN BEFORE AND AFTER LIVER-TRANSPLANTATION

We report results of serum thyroid hormone and IGF-1 concentrations in 20 children, 1.2 to 13.6 years old, with various degrees of chronic l iver dysfunction (CLD), before and after successful orthotopic liver t ransplantation (OLT). Ten children presented with moderate chronic liv er disease (CLD-M) with prothrombin time (PT) >50% and serum albumin c oncentration >3 g/dl; 7 children had severe chronic liver disease (CLD -S) with PT <50% and serum albumin concentration <3 g/dl; and 7 childr en who had received an OLT, who had normal liver function at the time of the study. Four of the latter group were also studied before OLT. P atients with CLD-M had normal mean +/-SD serum levels of total T-3 (2. 0+/-0.7 nmol/l), total T-4 (125+/-25.9 nmol/l) and fT(4) concentration s (16+/-2.8 pmol/l). In contrast, children with CLD-S showed a signifi cant decrease in thyroid hormones together with normal basal TSH value s (T-3 0.8+/-0.0 nmol/l; T-4 45.6+/-19.5 nmol/l; fT(4) 7.4+/-1.1 pmol/ l; TSH 3.8+/-0.9 mU/l). Patients who received a successful OLT showed mean peripheral thyroid hormone concentrations significantly higher th an CLD-S patients (T-3 1.7+/-0.7 nmol/l, p<0.005; T-4 92.8+/-18.2 nmol /l, p<0.001; fT(4) 14.5+/-3.1 pmol/l, p<0.001). A significant correlat ion was found between thyroid hormone levels and PT or serum albumin. In the nine patients with CLD-M and CLD-S in whom serum IGF-I concentr ation was measured, values found (mean+/-SD 0.08+/-0.05 U/ml) were bel ow the 95% confidence limit of matched controls. IGF-1 values normaliz ed after OLT, mean+/-SD: 1.5+/-1.13 U/ml (p<0.002). We conclude that a bnormalities in thyroid function accompanying liver disease are a grad ed phenomenon related to the severity of liver failure. Most of the th yroid hormone findings are comparable to those reported in adult patie nts with non-thyroidal illness including CLD patients. In contrast, IG F-1, which has rarely been measured in children with CLD, is as low in moderate as in severe liver dysfunction. Both abnormalities reversed after successful OLT.