Relationship between vitamin A deficiency and the thyroid axis in clinically stable patients with liver cirrhosis related to hepatitis C virus

• Published in: Applied physiology, nutrition, and metabolism Vol. 41; no. 9; pp. 985 - 991
• Main Authors: El-Eshmawy, Mervat M, Arafa, Mona M, Elzehery, Rasha R, Elhelaly, Rania M, Elrakhawy, Mohamed M, El-Baiomy, Azza A
• Format: Journal Article
• Language: English
• Published: Canada NRC Research Press 01.09.2016; Canadian Science Publishing NRC Research Press
• Subjects: Analysis; axe thyroïdien endogène; Bilirubin; Bilirubin - blood; cirrhose hépatique; Comparative analysis; Egypt - epidemiology; Female; Health aspects; Hepatitis; Hepatitis C; Hepatitis C - blood; Hepatitis C - pathology; Hepatitis C - physiopathology; Hepatitis C virus; Hospitals, University; Humans; Hyperthyroidism - diagnostic imaging; Hyperthyroidism - etiology; Hyperthyroidism - physiopathology; Liver - diagnostic imaging; Liver - physiopathology; Liver cirrhosis; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - etiology; Male; Metabolism; Middle Aged; Nutritional Status; Organ Size; Outpatient Clinics, Hospital; Physiological aspects; Prevalence; Risk factors; Severity of Illness Index; Socioeconomic factors; thyroid axis; Thyroid gland; Thyroid Gland - diagnostic imaging; Thyroid Gland - pathology; Thyroid Gland - physiopathology; Thyroid Hormones - blood; Thyrotropin; Thyrotropin - blood; Vitamin A; Vitamin A deficiency; Vitamin A Deficiency - epidemiology; Vitamin A Deficiency - etiology; Vitamin deficiency; vitamine A; Egypt; thyroid axis; cirrhose hépatique; vitamin A; axe thyroïdien endogène; liver cirrhosis; vitamine A
• ISSN: 1715-5312; 1715-5320
• DOI: 10.1139/apnm-2016-0056

Vitamin A deficiency (VAD) and altered thyroid function are commonly encountered in patients with liver cirrhosis. The link between vitamin A metabolism and thyroid function has been previously identified. The aim of this study was to explore the association between VAD and the thyroid axis in clinically stable patients with cirrhosis related to hepatitis C virus (HCV). One hundred and twelve patients with clinically stable HCV-related cirrhosis and 56 healthy controls matched for age, sex, and socioeconomic status were recruited for this study. Vitamin A status, liver function, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), reverse triiodothyronine (rT3), anti-thyroid peroxidase antibodies (anti-TPO), and thyroid volume were evaluated. The prevalence of VAD among patients with HCV-related cirrhosis was 62.5% compared with 5.4% among controls (P < 0.001). Patients with HCV-related cirrhosis had significantly higher FT4, FT3, TSH, and thyroid volume than did healthy controls. Of the 112 patients initially recruited, 18 were excluded (patients with subclinical hypothyroidism and/or anti-TPO positive), so a total of 94 patients with HCV-related cirrhosis were divided into 2 groups according to vitamin A status: VAD and normal vitamin A. Patients with VAD had significantly lower vitamin A intake and serum albumin and higher serum bilirubin, FT4, FT3, and TSH than patients with normal vitamin A status. Multiple logistic regression analysis revealed that VAD was associated with Child–Pugh score (β = 0.11, P = 0.05) and TSH (β = –1.63, P = 0.02) independently of confounding variables. We conclude that VAD may be linked to central hyperthyroidism in patients with clinically stable HCV-related liver cirrhosis.