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. 1992 Oct;68(804):804–810. doi: 10.1136/pgmj.68.804.804

Severity of alcoholic liver disease and markers of thyroid and steroid status.

P Burra 1, J A Franklyn 1, D B Ramsden 1, E Elias 1, M C Sheppard 1
PMCID: PMC2399541  PMID: 1461852

Abstract

Alcoholic liver disease is associated with abnormalities in circulating levels of thyroid, adrenal and gonadal steroid hormones. The relative importance of ethanol consumption and severity of liver disease in the aetiology of these changes and their relationship to clinical abnormalities are unclear. We studied 31 subjects with alcohol-induced liver disease divided into three groups according to the severity of histological features: fatty change, hepatitis and cirrhosis. Circulating concentrations of thyroid, adrenal and gonadal steroid hormones, together with their major binding proteins, were measured in all subjects, and changes related to histology and tests of liver function, as well as clinical endocrine status. A reduction in circulating free tri-iodothyronine (fT3) was seen in subjects with alcoholic hepatitis and cirrhosis, in association with normal or reduced levels of thyrotrophin (TSH). The absence of abnormalities in subjects with fatty change despite similar ethanol intake to the other groups, and correlations between fT3 and liver function tests, suggest that changes in fT3 reflect the severity of underlying liver disease. Similarly, marked increases in circulating cortisol in the hepatitis and cirrhosis groups, and correlations between cortisol and liver function, suggest that changes largely reflect hepatic disease. The absence of clinical features of hypothyroidism or Cushing's syndrome in these groups, despite abnormalities of fT3 and cortisol, suggest an altered tissue sensitivity to hormone effects. In contrast, increases in circulating oestradiol and reductions in testosterone were found in all three groups in males. These findings suggest that both direct effects of ethanol and hepatic dysfunction determine changes in gonadal steroids in males.

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Selected References

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  1. Borzio M., Caldara R., Borzio F., Piepoli V., Rampini P., Ferrari C. Thyroid function tests in chronic liver disease: evidence for multiple abnormalities despite clinical euthyroidism. Gut. 1983 Jul;24(7):631–636. doi: 10.1136/gut.24.7.631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Burr W. A., Ramsden D. B., Griffiths R. S., Black E. G., Hoffenberg R., Meinhold H., Wenzel K. W. Effect of a single dose of dexamethasone on serum concentrations of thyroid hormones. Lancet. 1976 Jul 10;2(7976):58–61. doi: 10.1016/s0140-6736(76)92283-2. [DOI] [PubMed] [Google Scholar]
  3. Chopra I. J., Hershman J. M., Pardridge W. M., Nicoloff J. T. Thyroid function in nonthyroidal illnesses. Ann Intern Med. 1983 Jun;98(6):946–957. doi: 10.7326/0003-4819-98-6-946. [DOI] [PubMed] [Google Scholar]
  4. Faber J., Kirkegaard C., Lumholtz I. B., Siersbaek-Nielsen K., Friis T. Variations in serum T3, rT3, 3,3'-diiodothyronine and 3',5'-diiodothyronine induced by acute myocardial infarction and propranolol. Acta Endocrinol (Copenh) 1980 Jul;94(3):341–345. doi: 10.1530/acta.0.0940341. [DOI] [PubMed] [Google Scholar]
  5. Frajria R., Angeli A. Alcohol-induced pseudo-Cushing's syndrome. Lancet. 1977 May 14;1(8020):1050–1051. doi: 10.1016/s0140-6736(77)91276-4. [DOI] [PubMed] [Google Scholar]
  6. Franklyn J. A., Gammage M. D., Ramsden D. B., Sheppard M. C. Thyroid status in patients after acute myocardial infarction. Clin Sci (Lond) 1984 Dec;67(6):585–590. doi: 10.1042/cs0670585. [DOI] [PubMed] [Google Scholar]
  7. Green J. R., Snitcher E. J., Mowat N. A., Ekins R. P., Rees L. H., Dawson A. M. Thyroid function and thyroid regulation in euthyroid men with chronic liver disease: evidence of multiple abnormalities. Clin Endocrinol (Oxf) 1977 Dec;7(6):453–461. doi: 10.1111/j.1365-2265.1977.tb01337.x. [DOI] [PubMed] [Google Scholar]
  8. Hadengue A., Moreau R., Lee S. S., Gaudin C., Rueff B., Lebrec D. Liver hypermetabolism during alcohol withdrawal in humans. Role of sympathetic overactivity. Gastroenterology. 1988 Apr;94(4):1047–1052. doi: 10.1016/0016-5085(88)90565-3. [DOI] [PubMed] [Google Scholar]
  9. Israel Y., Videla L., Bernstein J. Liver hypermetabolic state after chronic ethanol consumption: hormonal interrelations and pathogenic implications. Fed Proc. 1975 Oct;34(11):2052–2059. [PubMed] [Google Scholar]
  10. Israel Y., Walfish P. G., Orrego H., Blake J., Kalant H. Thyroid hormones in alcoholic liver disease. Effect of treatment with 6-n-propylthiouracil. Gastroenterology. 1979 Jan;76(1):116–122. [PubMed] [Google Scholar]
  11. Kahana L., Keidar S., Sheinfeld M., Palant A. Endogenous cortisol and thyroid hormone levels in patients with acute myocardial infarction. Clin Endocrinol (Oxf) 1983 Jul;19(1):131–139. doi: 10.1111/j.1365-2265.1983.tb00751.x. [DOI] [PubMed] [Google Scholar]
  12. Kaplan M. M., Larsen P. R., Crantz F. R., Dzau V. J., Rossing T. H., Haddow J. E. Prevalence of abnormal thyroid function test results in patients with acute medical illnesses. Am J Med. 1982 Jan;72(1):9–16. doi: 10.1016/0002-9343(82)90565-4. [DOI] [PubMed] [Google Scholar]
  13. Lieber C. S. Metabolic effects of ethanol and its interaction with other drugs, hepatotoxic agents, vitamins, and carcinogens: a 1988 update. Semin Liver Dis. 1988 Feb;8(1):47–68. doi: 10.1055/s-2008-1040528. [DOI] [PubMed] [Google Scholar]
  14. Nicoloff J. T., Fisher D. A., Appleman M. D., Jr The role of glucocorticoids in the regulation of thyroid function in man. J Clin Invest. 1970 Oct;49(10):1922–1929. doi: 10.1172/JCI106411. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Oppenheimer J. H., Bernstein G., Surks M. I. Increased thyroxine turnover and thyroidal function after stimulation of hepatocellular binding of thyroxine by phenobarbital. J Clin Invest. 1968 Jun;47(6):1399–1406. doi: 10.1172/JCI105831. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Oppenheimer J. H., Schwartz H. L., Mariash C. N., Kinlaw W. B., Wong N. C., Freake H. C. Advances in our understanding of thyroid hormone action at the cellular level. Endocr Rev. 1987 Aug;8(3):288–308. doi: 10.1210/edrv-8-3-288. [DOI] [PubMed] [Google Scholar]
  17. Oppenheimer J. H., Schwartz H. L., Shapiro H. C., Bernstein G., Surks M. I. Differences in primary cellular factors influencing the metabolism and distribution of 3,5,3'-L-triiodothyronine and L-thyroxine. J Clin Invest. 1970 May;49(5):1016–1024. doi: 10.1172/JCI106301. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Rees L. H., Besser G. M., Jeffcoate W. J., Goldie D. J., Marks V. Alcohol-induced pseudo-Cushing's syndrome. Lancet. 1977 Apr 2;1(8014):726–728. doi: 10.1016/s0140-6736(77)92169-9. [DOI] [PubMed] [Google Scholar]
  19. Sheppard M. C., Ramsden D. B. Abnormalities of thyroid function tests in hospital inpatients. Postgrad Med J. 1985 Nov;61(721):983–987. doi: 10.1136/pgmj.61.721.983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Smalls A. G., Kloppenborg P. W., Njo K. T., Knoben J. M., Ruland C. M. Alcohol-induced Cushingoid syndrome. Br Med J. 1976 Nov 27;2(6047):1298–1298. doi: 10.1136/bmj.2.6047.1298. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Van Thiel D. H., Lester R., Sherins R. J. Hypogonadism in alcoholic liver disease: evidence for a double defect. Gastroenterology. 1974 Dec;67(6):1188–1199. [PubMed] [Google Scholar]
  22. Van Thiel D. H., Lester R. The effect of chronic alcohol abuse on sexual function. Clin Endocrinol Metab. 1979 Nov;8(3):499–510. doi: 10.1016/s0300-595x(79)80028-6. [DOI] [PubMed] [Google Scholar]
  23. Westgren U., Ahrén B., Burger A., Ingemansson S., Melander A. Effects of dexamethasone, desoxycorticosterone, and ACTH on serum concentrations of thyroxine, 3,5,3'-triiodothyronine and 3,3',5'-triiodothyronine. Acta Med Scand. 1977;202(1-2):89–92. doi: 10.1111/j.0954-6820.1977.tb16790.x. [DOI] [PubMed] [Google Scholar]
  24. Wilber J. F., Utiger R. D. The effect of glucocorticoids on thyrotropin secretion. J Clin Invest. 1969 Nov;48(11):2096–2103. doi: 10.1172/JCI106176. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Williams G. R., Franklyn J. A., Neuberger J. M., Sheppard M. C. Thyroid hormone receptor expression in the "sick euthyroid" syndrome. Lancet. 1989 Dec 23;2(8678-8679):1477–1481. doi: 10.1016/s0140-6736(89)92930-9. [DOI] [PubMed] [Google Scholar]
  26. Wilson N. M., Brown P. M., Juul S. M., Prestwich S. A., Sönksen P. H. Glucose turnover and metabolic and hormonal changes in ethanol-induced hypoglycaemia. Br Med J (Clin Res Ed) 1981 Mar 14;282(6267):849–853. doi: 10.1136/bmj.282.6267.849. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. van Thiel D. H., Gavaler J. S., Cobb C. F., Sherins R. J., Lester R. Alcohol-induced testicular atrophy in the adult male rat. Endocrinology. 1979 Oct;105(4):888–895. doi: 10.1210/endo-105-4-888. [DOI] [PubMed] [Google Scholar]

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