Hepatic failure - drvirgo

[ArchivalUser]

hey guys help me out with this q plz
What are levels of totalT4 ,free T4 and TSH in severe liver disease???

[ArchivalUser]

hi drvirgo, the only correlation between thyroid function n liver I can make is related to thyroid binding globulin(TBG).

Total serum T4 = T4 bound to TBG and free (unbound) T4 (FT4)

The liver synthetise TBG, in patient with:

1)- acute hepatitis plasma TBG rise in parallel with transaminase activity, this result in
rise in T4, but FT4 and TSH remain normal.

2)-chronic hepatitis, the liver ability to make TBG decrease, so T4 decrease(the coversion of T4 to T3 also decrease), FT4 and TSH remain normal. But TSH could be slightly elevated because of feedback relationship with circulating T4 and T3.

Good question, I did not answer your question but maybe someone will clarify in case of severe liver disease.

[ArchivalUser]

i think tsh up.t4 up,and totalt4 down

[ArchivalUser]

total serum T4 decrease, free T4 and TSH normal
liver failure lead to fall in TBG, new equilibrium is set with release of free T4, this increase negative feedback, T4 release from thyroid is decrease, returning to NORMAL LEVEL, AS WELL AS TSH

[ArchivalUser]

thanks everyone for clearing this q.so in liver failure-TBG fall >>total serum T4 decrease, free T4 and TSH normal.

[ArchivalUser]

Thanks drvirgo, as I mentioned b4, is there any diff between acute liver disease and chronic liver disease about TBG?