The investigation of thyroid functions in pediatric age groupwith chronic liver diseases

Background and Aim: Although the mechanism, pathophysiology and clinical course of primary thyroid disease are well known, we have little knowledge of the changes that occur in thyroid hormone metabolism in chronic systemic diseases, especially chronic liver diseases. The limited number of studies on this subject is mostly on adults. We aimed to identify the disorders in thyroid function tests that can be seen in the course of chronic liver diseases seen in childhood. Materials and Methods: In this study, 107 (53 female, 54 male) patients has been taken part in the study whose thyroid function tests are examined by scanning the files of 500 patients between one month-18 year who has been observed the diagnosis of chronic liver disease by Dokuz Eylül University Faculty of Medicine, Departmant of Pediatric Gastroenterology and Hepatology Unit, between 2005 and 2018 . Patients' anthropometric data (age, gender, body weight, height, body mass index), liver function test values; AST, ALT, GGT, ALP, Tbil, Dbil, Ibil, Alb, T.protein and thyroid function test values ( TSH, fT4, fT3, thyroglobulin, Anti-TPO, Anti-Tg,) whether or not treatment was obtained based on file information. Patients' age, body weight, body mass index, liver function test values and thyroid function test values were recorded to statistical datas by using decimal numbers. Findings: 53 (49.5%) of the patients were female, 54 (50.5%) were male and the median age was 1,50 (0,3-11,0) years. In the study, 14 patients (13%) had chronic viral hepatitis (13 cases had chronic hepatitis B and one case had chronic hepatitis C), 34 patients (31.5%) had cholestasis and five patients (4.7%) had autoimmune hepatitis. 11 patients (10,2%) had Wilson's disease, 22 patients (19.8%) had chronic liver disease due to congenital metabolic diseases (tyrosinemia, glycogen storage diseases, zelweger's disease, galactosemia, hemochromatosis), eight patients (7.5%) had idiopathic hepatitis, five patients had cirrhosis (4.5%) (three cryptogenic cirrhosis, one congenital hepatic fibrosis and one chemotherapeutic secondary liver fibrosis), three patients (2.8%) had cystic fibrosis, three patients (2.8%) had idiopathic portal hypertension and in two patients (1.9%) had Hydatid cyst. 4 Ninety-six (89,7%) of the 107 patients who were evaluated TFT was normal, seven of the patients (6,5%) were subclinical hypothyroidism and four of the patients (3.7%) were diagnosed by euthyroid syndromes. Of the seven patients with subclinical hypothyroidism, one (14.2%) had glucogen storage diasease, one (14.2%) had biliary atresia, one (14.2%) had undiagnosed cholestatic liver disease, one (14.2%) had Alagille syndrome, one (14.2%) had idiopatic hepatitis, one (14.2%) had progressive familial intrahepatic cholestasis (PFIC) and one (14.2%) had congenital hepatic fibrosis. When we look the distribution of the diagnoses of the patients who were diagnosed as sufferd from euthyroid syndrome , one patient (25%) had congenital hepatic fibrosis, two patients (50%) had cholestatic liver disease and one patient (25%) had cryptogenic cirrhosis-related liver transplantation. Conclusion: In general, most of the patients who are suffering from chronic liver diseases as we found in our study (TFT normal in 89.7% of patient) , the patient is clinically euthyroid Processes similar to those seen in patient euthyroid syndrome may occur in different types of liver disease; but there may also be a variety of altered clinics specific to the type or stage of liver disease.In the literature, a small number of case reports in the pediatric age group are on this issue, while the number of studies done in adult patients is very limited. Patients with glycogen storage disease type 1b, autoimmune hepatitis and chronic hepatitis C infections have been shown to be more risky subtypes in terms of thyroid dysfunction. In our study, predisposition to thyroid dysfunction was found in patients with cholestasis, and this tendency was also found in the Dbil and fT3 values of patients in the Spearman correlation analysis. No research has been found in the literature on this topic. Children with chronic liver disease also need to be followed for thyroid dysfunctions. Types of thyroid dysfunction that can develop are different in the subtypes of chronic liver diseases. We believe that this descriptive study will contribute to clinicians' clinical follow-up of chronic liver disease and to the literature as a guideline for the treatment stage of thyroid dysfunctions.