What is the role of liver disease in the development of euthyroid sick syndrome?

Updated: Apr 27, 2017
  • Author: Serhat Aytug, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Abnormalities of thyroid function test results are common in patients with liver disease. These abnormalities vary depending on the type and severity of the liver disease. The liver probably is the most important site for conversion of T4 to T3; decreases in T3 generation may reflect a direct effect of liver disease on the deiodinative process rather than an indirect effect of systemic illness. Liver disease affects thyroid hormone transport in blood significantly because synthesis of all 3 of the binding proteins, ie, TBG, TBPA, and albumin, occurs in the liver. In cirrhosis, thyroid function test result abnormalities depend on the amount of residual functional liver tissue. Generally, total T4 is unchanged or reduced, free T4 is unchanged or elevated, free T3 is reduced or unchanged, and rT3 is elevated. In contrast to most of the other low T3 syndrome categories, basal TSH may be elevated.


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