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Is bile flow reduced in patients with hypothyroidism?
Johanna Laukkarinen1, Juhani Sand, Rauni Saaristo
1Department of Surgery, Tampere University Hospital, Tampere, Finland.
Surgery
|March 28, 2003
Summary
Hypothyroidism slows biliary tract emptying, potentially increasing the risk of common bile duct stones (CBDS). Restoring thyroid function (euthyroidism) normalized these biliary dynamics, suggesting a link between thyroid hormones and bile flow regulation.
Area of Science:
- Gastroenterology and Hepatology
- Endocrinology
- Biliary System Physiology
Background:
- Sphincter of Oddi (SO) dysfunction can impede bile flow, contributing to common bile duct stone (CBDS) formation.
- Previous research indicated a higher prevalence of hypothyroidism in CBDS patients and demonstrated thyroxine's inhibitory effect on SO contractility.
- Hypothyroidism has been associated with reduced bile flow to the duodenum in animal models.
Purpose of the Study:
- To investigate the impact of altered thyroid gland function on human biliary dynamics.
- To compare biliary tract emptying in hypothyroid versus euthyroid states in female patients.
Main Methods:
- Quantitative (99m)Tc HIDA cholescintigraphy (QC) and biliary ultrasonography were employed.
- Eight female patients (1 hypothyroid, 7 post-thyroidectomy) were assessed in both hypothyroid and euthyroid (post-thyroxine replacement) stages.
- Each patient served as her own control to evaluate changes in biliary dynamics.
Main Results:
- Quantitative (99m)Tc HIDA cholescintigraphy revealed decreased hepatic clearance at 45 and 60 minutes in the hypothyroid state.
- Hilum-duodenal transit time was significantly increased by 31% in hypothyroidism compared to euthyroidism.
- No significant changes were observed in gallbladder or bile duct dimensions via ultrasonography; however, serum hypercholesterolemia was noted during hypothyroidism.
Conclusions:
- Hypothyroidism is associated with delayed biliary tract emptying, as evidenced by QC findings.
- Altered biliary emptying, alongside previously suggested changes in bile composition and excretion, may contribute to the increased prevalence of CBDS in hypothyroidism.
- The prorelaxing effect of thyroxine on the sphincter of Oddi, absent in hypothyroidism, likely plays a role in these observed biliary dynamic changes.