Association of Liver Enzymes with Thyroid Hormone Levels in Hyperthyroid Patients: A Cross-Sectional Study from a Tertiary Care Hospital
Association of Liver Enzymes with Thyroid Hormone Levels in Hyperthyroid Patients
DOI:
https://doi.org/10.54393/pjhs.v6i9.3339Keywords:
Thyroid Stimulating Hormone, Triiodothyronine, Liver Function Tests, Alanine Aminotransferase, Aspartate Aminotransferase, Alkaline PhosphataseAbstract
Hyperthyroidism, characterized by the overproduction of thyroid hormones, may impact liver function. Understanding this relationship is essential for early identification and management of liver dysfunction in hyperthyroid patients. Objectives: To determine the association between thyroid hormone levels (TSH, T3, T4) and liver function tests (ALT, AST, ALP, bilirubin, and total protein) in patients with hyperthyroidism.
Methods: This cross-sectional study was conducted from 28 July 2023 to 28 January 2024 at the Endocrinology OPD of Gulab Devi Hospital, Lahore. A total of 100 hyperthyroid patients were selected using non-probability sampling. Demographic data, thyroid profiles (T3, T4, TSH), and liver function tests (LFTs) were recorded. Data were analyzed by SPSS version 26.0 using descriptive statistics and Chi-square tests to assess associations. Results: Out of 100 hyperthyroid patients, 59 were female and 41 were male, with a mean age of 38.5 + 10.2 years. Elevated ALT was observed in 27% of patients, AST in 13%, ALP in 23%, bilirubin in 13%, and total protein in 11%. Chi-square analysis showed significant associations between TSH and ALT (p=0.028) and AST (p=0.017), as well as between T3 and ALP (p=0.031). No significant associations were found between T4 and any of the liver enzymes. Conclusions: A significant proportion of hyperthyroid patients showed abnormal LFTs, indicating a relationship between thyroid dysfunction and hepatic involvement. Further large-scale studies are recommended
References
Ali NH and Majeed AA. Thyroid Hormone Concentration and Receptor. Egyptian Academic Journal of Biological Sciences B Zoology. 2022 Apr; 14(1): 221-30. doi: 10.21608/eajbsz.2022.233650.
Khandaker MS, Rasel Ahmed MA, Hoque M, Rahman MM. Thyroid Imbalance and Hypothyroidism: A Review. Medical Education Research Journal of Pharmaceutical Sciences. 2025 ; 5(2): 1-7. doi: 10.36348/merjps.2025.v05i02.001.
Salas-Lucia F and Bianco AC. T3 Levels and Thyroid Hormone Signaling. Frontiers in Endocrinology. 2022 Oct; 13: 1044691. doi: 10.3389/fendo.2022.1044691.
Inman BL and Long B. Thyrotoxicosis. Emergency Medicine Clinics of North America. 2023 Jul; 41(4): 759-74. doi: 10.1016/j.emc.2023.06.005.
Khan AR, Javaid F, Altaf S, Chaudhry A, Inam S, Sherwani HK. Cardio-Hepatic Interactions in Acute Heart Failure: A Study on Liver Function Test Abnormalities. Annals of King Edward Medical University. 2025 Mar; 31(1): 1-7. doi: 10.21649/akemu.v31i1.5759.
Sivertsson E, Friederich-Persson M, Persson P, Nangaku M, Hansell P, Palm F. Thyroid Hormone Increases Oxygen Metabolism Causing Intrarenal Tissue Hypoxia: A Pathway to Kidney Disease. Public Library of Science One. 2022 Mar; 17(3): e0264524. doi: 10.1371/journal.pone.0264524.
Mukherjee S, Samanta L, Roy A, Bhanja S, Chainy GB. Supplementation of T3 Recovers Hypothyroid Rat Liver Cells from Oxidatively Damaged Inner Mitochondrial Membrane Leading to Apoptosis. BioMed Research International. 2014 ; 2014(1): 590897. doi: 10.1155/2014/590897.
Piantanida E, Ippolito S, Gallo D, Masiello E, Premoli P, Cusini C, et al. The Interplay between Thyroid and Liver: Implications for Clinical Practice. Journal of Endocrinological Investigation. 2020 Jul; 43(7): 885-99. doi: 10.1007/s40618-020-01208-6.
Ahmed SK. How to Choose a Sampling Technique and Determine Sample Size for Research: A Simplified Guide for Researchers. Oral Oncology Reports. 2024 Dec; 12: 100662. doi:10.1016/j.oor.2024.100662.
Youssef EM and Wu GY. Subnormal Serum Liver Enzyme Levels: A Review of Pathophysiology and Clinical Significance. Journal of Clinical and Translational Hepatology. 2024 Mar; 12(4): 428-35. doi: 10.14218/JCTH.2023.00446.
Ritter MJ, Amano I, Hollenberg AN. Thyroid Hormone Signaling and the Liver. Hepatology. 2020 Aug; 72(2): 742-52. doi: 10.1002/hep.31296.
Olanrewaju OA, Asghar R, Makwana S, Yahya M, Kumar N, Khawar MH, et al. Thyroid and its Ripple Effect: Impact on Cardiac Structure, Function, and Outcomes. Cureus. 2024 Jan; 16(1): e51574. doi: 10.7759/cureus.51574.
Videla LA and Valenzuela R. Perspectives in Liver Redox Imbalance: Toxicological and Pharmacological Aspects Underlying Iron Overloading, Nonalcoholic Fatty Liver Disease, and Thyroid Hormone Action. BioFactors. 2022 Mar; 48(2): 400-15. doi: 10.1002/biof.1797.
Zhang R, Tian X, Qin L, Wei X, Wang J, Shen J. Factors Predicting Abnormal Liver Function Tests Induced by Graves' Disease Alone: A Retrospective Cohort Study. Medicine. 2015 May; 94(19): e839. doi: 10.1097/MD.0000000000000839.
Hsieh A, Adelstein S, McLennan SV, Williams PF, Chua EL, Twigg SM. Liver Enzyme Profile and Progression in Association with Thyroid Autoimmunity in Graves' Disease. Endocrinology Diabetes, and Metabolism. 2019 Oct; 2(4): e00086. doi: 10.1002/edm2.86.
Masarone M, Rosato V, Dallio M, Gravina AG, Aglitti A, Loguercio C, et al. Role of Oxidative Stress in Pathophysiology of Nonalcoholic Fatty Liver Disease. Oxidative Medicine and Cellular Longevity. 2018; 2018(1): 9547613. doi: 10.1155/2018/9547613.
Wen X, Ding X, Chang X, Wang J, Wang Q, Liu J, et al. Elevated Serum Meteorin-like Levels in Patients with Hyperthyroidism. BMC Endocrine Disorders. 2022 Dec; 22(1): 304. doi: 10.1186/s12902-022-01229-7.
Yorke E. Hyperthyroidism and Liver Dysfunction: A Review of a Common Comorbidity. Clinical Medicine Insights: Endocrinology and Diabetes. 2022 Feb; 15: 11795514221074672. doi: 10.1177/11795514221074672.
Hasan AH, Abdulzahra MA, Hashim AM, Al-Mawlah YH. Biochemical Markers of Liver Function Test (ALT, AST, ALP) in Thyroid Dysfunction (Hyperthyroidism and Hypothyroidism). Journal of Biotech Research. 2024; 16: 167-74.
Sabatino L, Vassalle C, Del Seppia C, Iervasi G. Deiodinases and the Three Types of Thyroid Hormone Deiodination Reactions. Endocrinology and Metabolism. 2021 Oct; 36(5): 952-64. doi: 10.3803/EnM.2021.1198.
Shah J, Jan MR, Yousaf M. Effects of Thyroidal Dysfunctions on Bone Markers in Non-pregnant Women: A Hospital-Based Cross-Sectional Study from Khyber Pakhtunkhwa, Northern Pakistan. Journal of Postgraduate Medical Institute. 2017 May; 31(2): 1-6.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Health Sciences

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments