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Thyroid dysfunction does not impact hepatic complications in PBC

Associated thyroid dysfunctions are often found in patients with primary biliary cholangitis. However, new research showed that thyroid disease does not directly influence the rate or progression of hepatic complications or transplant-free survival in these patients.

Annarosa Floreani, MD, department of surgery, oncology and gastroenterology, University of Padova, Italy, and colleagues aimed to determine the association between PBC and thyroid dysfunction (TD) through the evaluation of 921 patients with PBC at two clinical centers in Padova and Barcelona, Spain. They also looked to determine whether this type of association made an impact on the natural history of PBC.

Floreani and colleagues recorded and evaluated data on patients’ histological stage at diagnosis, biochemical data, associated extrahepatic autoimmune conditions and clinical events, including hepatic decompensation. The mean follow-up was 126.9 ± 91.7 months.

“The frequency of TD in autoimmune liver diseases is substantially higher than in the general population,” the researchers wrote. “Since fatigue, lethargy anorexia and hypercholesterolemia are common features of both hypothyroidism and PBC, patients with PBC should be screened for evidence of TD. … Little attention has been paid in the literature to the influence of TD on the natural history of PBC.”

Some 150 of the patients had TD: 94 had Hashimoto’s thyroiditis; 15 had Graves’ disease; 22 had multinodular goiter; 7 had thyroid cancer; and 12 reported other thyroid conditions.

The different types of TD and their prevalence were similar between patients seen at the different centers. However, in the Padova cohort, Graves’ disease (15.7% vs. 5%) and thyroid cancer were more prevalent (8.6% vs. 1.3%; P < .05) compared with the Barcelona cohort.

There were no observed differences between patients with and without TD related to histological stage at diagnosis, hepatic decompensation events, occurrence of HCC and liver transplantation rate.

The presence of associated TD was not associated with lower survival for patients with PBC in either cohort, according to the research. The overall survival rates were similar between the two cohorts, but when patients without TD were examined separately, patients in the Padova cohort had lower survival compared with those in the Barcelona cohort (P = .001).
The researchers acknowledged limitations of their work: methodological bias among design of the study, data were collected using all the same criteria, all medical histories were checked by patients’ medical doctors but this was not standardized and lack of data on causes of mortality could create bias in the survival data.

They concluded: “TDs — and particularly [Hashimoto’s thyroiditis]— are often associated with PBC, but do not influence the rate of hepatic complications or the natural history of the latter disease.” – by Melinda Stevens