NUTRITIONAL AND PROGNOSTIC-SIGNIFICANCE OF SERUM HYPOTHYROXINEMIA IN HOSPITALIZED-PATIENTS WITH LIVER-CIRRHOSIS

Background/Aims: A variety of severe illnesses can induce changes in t hyroid hormone metabolism, leading to findings referred to as ''sick e uthyroid syndrome''. In several groups of patients the reduction of se rum thyroxine concentration (T-4), characteristic of the low-T-4 varia nt of sick euthyroid syndrome, has been found to be a good predictor o f survival. Although the pathophysiology of hormonal alterations has n ot yet been defined, nutritional deficits have been suggested to play a role. The study aimed to define the prognostic and nutritional signi ficance of serum thyroxine in liver cirrhosis. Methods: Thyroid hormon es and nutritional status were evaluated in a group of 75 consecutive hospitalized patients with cirrhosis, followed-up clinically for 12 mo nths. Results: A low-T-4 variant of sick euthyroid syndrome was found in 23 of the 75 enrolled patients with cirrhosis (30.6%). Serum T-4, b ut not serum T-3, correlated with mid-arm muscle circumference (p<0.01 ), an indicator of muscle protein compartment. While both serum T-3 an d T-4 correlated directly with serum proteins and inversely with Child -Pugh score, only T-4 was predictive of outcome. Patients with the low -T-4 variant of sick euthyroid syndrome showed significantly lower sho rt-and long-term survival rates compared to those with normal serum T- 4 concentrations (p<0.008 at 3 months, p<0.001 at 6 months and 1 year) . A multivariate analysis using the proportional hazards Cox's regress ion procedure showed that serum T-4, but not serum T-3 or nutritional parameters, improves the prognostic capacity of Child-Pugh score (p<0. 01). Conclusions: These data indicate that the low T-4-variant of sick euthyroid syndrome distinguishes a subgroup of patients with cirrhosi s at risk for decreased survival. The inclusion of T-4 in the Child-Pu gh score, by improving its prognostic power, may optimize the selectio n of patients with advanced cirrhosis to receive specific therapy such as transplantation.