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Thyroid function and serum IGF-1 in children before and after liver transplantation
T Pasqualini1, P Fainstein-Day, R Gutman
1Departamento de Pediatria, Hospital Italiano de Buenos Aires, Argentina.
Insights
Children with severe chronic liver disease (CLD-S) exhibit reduced thyroid hormones and IGF-1. Successful liver transplantation (OLT) improves thyroid hormone levels, correlating with liver function markers.
Area of Science:
- Pediatric Endocrinology
- Hepatology
- Transplantation Medicine
Background:
- Chronic liver dysfunction (CLD) in children can impact endocrine function.
- Thyroid hormones and Insulin-like Growth Factor-1 (IGF-1) are crucial for growth and metabolism.
- The effects of CLD and liver transplantation on these hormones require further investigation.
Purpose of the Study:
- To assess serum thyroid hormone and IGF-1 levels in children with varying degrees of CLD.
- To evaluate the impact of successful orthotopic liver transplantation (OLT) on these hormone levels.
- To explore correlations between hormone levels and markers of liver function.
Main Methods:
- Serum concentrations of total T3, total T4, free T4 (fT4), TSH, and IGF-1 were measured.
- Patients were categorized into moderate CLD (CLD-M), severe CLD (CLD-S), and post-OLT groups.
- Liver function was assessed using prothrombin time (PT) and serum albumin levels.
Main Results:
- Children with CLD-M had normal thyroid hormone levels, while CLD-S patients showed significantly decreased T3, T4, and fT4 with normal TSH.
- Post-OLT patients exhibited significantly higher thyroid hormone levels compared to CLD-S patients.
- Thyroid hormone levels correlated significantly with PT and serum albumin.
- IGF-1 levels were below normal in children with CLD-M and CLD-S.
Conclusions:
- Severe chronic liver disease in children is associated with significant hypothyroidism.
- Successful OLT can restore peripheral thyroid hormone levels towards normal.
- Thyroid hormone status is linked to the severity of liver dysfunction and improves post-transplantation.
Abstract:
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 liver dysfunction (CLD), before and after successful orthotopic liver transplantation (OLT). Ten children presented with moderate chronic liver disease (CLD-M) with prothrombin time (PT) > 50% and serum albumin concentration > 3 g/dl; 7 children had severe chronic liver disease (CLD-S) with PT < 50% and serum albumin concentration < 3 g/dl; and 7 children 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. Patients with CLD-M had normal mean +/- SD serum levels of total T3 (2.0 +/- 0.7 nmol/l), total T4 (125 +/- 25.9 nmol/l) and fT4 concentrations (16 +/- 2.8 pmol/l). In contrast, children with CLD-S showed a significant decrease in thyroid hormones together with normal basal TSH values (T3 0.8 +/- 0.0 nmol/l; T4 45.6 +/- 19.5 nmol/l; fT4 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 than CLD-S patients (T3 1.7 +/- 0.7 nmol/l, p < 0.005; T4 92.8 +/- 18.2 nmol/l, p < 0.001; fT4 14.5 +/- 3.1 pmol/l, p < 0.001). A significant correlation 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-1 concentration was measured, values found (mean +/- SD 0.08 +/- 0.05 U/ml) were below the 95% confidence limit of matched controls.
