85.dr monali rewatkar ONLINE.cdr INTRODUCTION Thyroid diseases are among the commonest endocrine disorders worldwide, it has been estimated that about 42 million people in India suffer from thyroid diseases. Hypothyroidism is the common thyroid disorder with the prevalence of 3.9% in India [3]. Thyroid hormones are essential for normal organ growth and development.Thyroid hormones regulate the basal metabolic rate of all cells, so alteration in there level can affects the entire metabolism. Thyroid hormones regulate hepatocytes and thereby modulate hepatic function. The liver in turn metabolizes the thyroid hormones and regulates their systemic endocrine effect.[4,5] Thyroid dysfunction may perturb liver function. Knowledge of the association between hypothyroidism and deranged biochemical markers of liver function is important for the clinician, to consider an evaluation of thyroid function in the work up of the patient with altered liver function tests.[6,14] This may emphasize the need for monitoring liver function in hypothyroid patients and vice versa. The present study was undertaken to study the inuence of thyroid hormones on liver function (transaminases) in hypothyroidism.Present study was done to evaluate the biochemical parameters of thyroid function test (T3, T4, TSH) and liver function test (AST,ALT and ALP) and to nd out any possible correlation among the measured parameters. OBJECTIVES OF THE STUDY 1) To evaluate the effect of thyroid dysfunction on liver function tests 2) To study Pearsons correlation between Liver enzymes & thyroid prole METHOD OF COLLECTION OF DATA & SELECTION OF SUBJECTS: This study include about 100 patients attending the clinical Biochemistry OPD, IGGMC, Nagpur for routine thyroid test. History was taken as per designed proforma and consent form was obtained. We collect 5 ml blood sample in plain bulb. Collected sample was analysed for Liver enzymes as well as thyroid test ie T3,T4 & TSH. Thyroid tests was run on Elisa ( reader & washer). Serum values of Thyroid stimulating hormone (TSH), thyroxine (T4) and tri-iodo thyronine (T3) were assayed by ELISA tests and values were compared & correlated with Liver enzymes ( AST,ALT,ALP). Liver Function Tests – Normal Range - Alanine Transaminases IMPLICATIONS OF THYROID DYSFUNCTION ON LIVER ENZYMES Original Research Paper Dr Monali Rewatkar Assistant Professor, Biochemistry Department Indira Gandhi Government Medical College, Nagpur, Maharashtra, India X 39GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Biochemistry BACKGROUND: The liver has an important role in thyroid hormone metabolism. Normal level of thyroid hormones also important for normal hepatic function [1].Thyroid disorders often accompany abnormal serum enzyme levels and disturbances in liver functions. Thyroid diseases may be associated with elevation of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase(ALP).[2] Thyroid hormones regulate the basal metabolic rate of all cells including hepatocytes, and hence, modulate hepatic function; the liver in turn metabolizes the thyroid hormones and regulates their systemic endocrine effects .[3] Thyroid dysfunction may perturb liver function .So, the objective of this study is to evaluate the changes in liver function in thyroid dysfunction. AIMS: Aim of the present study is to determine the biochemical markers of liver function test ie Aspartate transaminase (AST), Alanine transaminase (ALT) and Alkaline phosphatase (ALP) in patients with thyroid dysfunction and to evaluate the effect of altered thyroid hormones on liver function tests . Also to nd their possible correlation ie Pearsons correlation between Liver specic enzymes & thyroid hormones in patients attending clinical biochemistry OPD at tertiary care Unit, IGGMC,Nagpur. MATERIALS & METHODS – This study include about 100 patients attending clinical Biochemistry OPD, IGGMC, Nagpur for routine thyroid test. Estimations of thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH) done & Liver specic enzymes like activities of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) estimated in all patients..Collected sample was analysed for liver enzymes, run on Autoanalyser EM 460 in clinical Biochemistry Laboratory,IGGMC,Nagpur. Thyroid tests was run on Elisa reader & washer . Serum values of Thyroid stimulating hormone (TSH), thyroxine (T4) and tri-iodo thyronine (T3) were assayed by ELISA tests and values were compared & correlated with Liver enzymes level .The data was analysed & Pearsons Correlation was obtained, p value <0.05 considered as signicant. RESULTS: Results of our study shows Positive Pearsons correlation between TSH & Liver enzymes in thyroid dysfunction while there is Negative Pearsons correlation between T3,T4 with Liver enzymes. P value is found to be statistically signicant ie <0.05 . CONCLUSIONS: Thyroid dysfunction patients should be regularly checked for biochemical parameters of Liver enzymes. It can be concluded that thyroid hormones altered liver function tests. It is thus recommended that liver function tests interpretation in thyroid dysfunction must be advised to prevent progression of disease. ABSTRACT KEYWORDS : Liver Function Test, Thyroid Dysfunction , T3, T4, Tsh, Ast, Alt And Alp VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr Arun Tadas * Professor & Head, Biochemistry Department Indira Gandhi Government Medical College, Nagpur, Maharashtra, India *Corresponding Author Sanjay Agrawal Statistitian PSM Department, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India Prayas Nimbarte Intern, Biochemistry Department, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India 40 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS (ALT)- 10 to 40 IU/L, Aspartate Transaminases (AST) -10 to 40 IU/L , Alkaline Phosphatase (ALP) – 44 to 147 IU/L, were estimated on fully Analyzer EM 460 For T3, T4, TSH – Immunoassay Elisa kit method on Elisa Reader & Washer Normal Range –T3 - 0.52 to 1.85 ng/ml, T4 - 5 to 15 ug/dl, TSH – 0.39 to 6.16 uIU/ml Analysis was carried on Autoanalyser EM – 460 in clinical Biochemistry lab, IGGMC for Serum AST,ALT & ALP . All estimations was done & their values were compared & correlated. The data was analysed & Pearsons Correlation was obtained, & . P value <0.05 was considered statistically signicant. RESULTS Table No 1 : Mean Values of T3, T4, TSH ( Thyroid Test) & AST , ALT, ALP ( Liver enzymes) Table No 2 : Pearsons Correlation between Thyroid Horm ones & Liver specic Enzymes **. Correlation is signicant at the 0.01 level (2-tailed). DISCUSSION Result of our study shows TSH level (Mean - 5 .63) shows positive correlation with serum enzymes specic for liver ie AST,ALT & ALP by Pearsons correlation (Table 2) Similarly Vice versa with T3 ,T4 shows Negative Pearsons Correlation with liver specic enzymes. The ndings of our study is in corroboration with ndings of the study by Kalita N et al,[6] Yadav A. et al.[7], p.d Grifths et al [8] and Pandey R. et al.[9] Malik and Hodgson[10] mentioned that thyroid hormones T3 and T4 are essential for the growth, development and function of all organs of the body. They regulate BMR of all cells of the body including the hepatocytes and thereby modulate hepatic function. The liver in turn metabolises thyroid hormones and regulates their systemic endocrine effects. Therefore thyroid dysfunction may disturb liver function and liver disease affects thyroid hormone metabolism and a variety of systemic diseases affect both organs. It highlights a close relationship between thyroid and liver in health and disease. In our study TSH level showed signicant positive correlation with AST, ALT and ALP levels in thyroid dysfunction. (Table 2 ). Our study may be explained by the observations made by Targhar G. et al [11], Khan T. et al [12] and Prakash A. et al[13]. that thyroid alteration effects the liver enzymes like ALP,AST and ALT. The Pearsons positive correlation of TSH levels with AST and ALT levels is statistically signicant ( p <0.05) CONCLUSION – To conclude, the present study indicates that thyroid disorder might cause signicant effect on metabolism of various cells like hepatocytes reected by increase in biochemical param eters of liver function test ie activity of AST, ALT and ALP . This suggests that hypothyroid patients should be regularly checked for biochemical parameters of liver function tests. Early detection and treatment can prevent the further complications related to the disorder and will be helpful during the management of thyroid patients. REFERENCES 1. Klion F.M., Segal R., Schaffner F. The effect of altered thyroid function on the ultrastructure of the human liver.1971; 50: p.317-24. 2. Mane A, Bhagwat V. Serum enzymes and liver function tests in thyroid disorders. Biomedicine 2011; 31: 517– 522 3. Huang MJ, Liaw YF. Clinical associations between thyroid and liver diseases. J Gastroenterol Hepatol 1995; 10:344–50. 4. Manjula K. S, Priyadarshini K. S, H. V. Shetty, Usha S.M.R, Reena. R. Study of serum transaminases in hypothyroidism. Journal of Evolution of Medical and Dental Sciences 2013;2:230-234 5. Hasan B, Ibrahim N. Estimation of thyroid hormones and liver enzymes levels in hypo and hyperthyroidism in iraqi women. Int j pharm bio sci 2016;7: 707 – 713 6. Kalita N, Devi R, Ahmed S. Inuence of hypothyroidism on biochemical markers of liver function test: a cross sectional study. Indian Journal of Basic and Applied Medical Research 2016; 5:478-490 7. Yadav A., Arora S., Saini V., Arora MK., Singh R., Bhattacharjee J. Inuence of thyroid hormones on biochemical parameters of liver function: a case- control study in North Indian population. 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Bandebuche S, Jagtap S.Study of liver and kidney function tests in patients of hypothyroidism.International Journal of Biochemistry. 2017;4:66-69 VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Mean Std. Deviation N T3 1.0427 .34098 100 T4 6.55 2.650 100 TSH 5.634 4.7064 100 AST 48.020 39.7865 100 ALT 49.890 42.0221 100 ALP 167.440 79.7502 100 Correlation AST ALT ALP T3 Pearson Correlation Sig. (2-tailed) N -.734** 0.000 100 -.783** 0.000 100 -.664** 0.00 100 T4 Pearson Correlation Sig. (2-tailed) N -.723** 0.000 100 -.778** 0.000 100 -.727** 0.000 100 TSH Pearson Correlation Sig. (2-tailed) N .696** 0.000 100 .736** 0.000 100 .695** 0.000 100