Skip to main content

Advertisement

SpringerLink
Log in

Increased incidence of hypothyroidism in primary biliary cirrhosis

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

We examined the thyroid status of 58 patients with primary biliary cirrhosis (PBC) using total serum thyroxin, thyroid hormone binding ratio, free thyroxin index, serum TSH, antithyroglobulin, and antimicrosomal antibodies. Seven patients were known to be hypothyroid prior to the diagnosis of PBC. Six additional patients were found to have biochemical evidence of hypothyroidism. The prevalence of hypothyroidism was 12% if we include only those six PBC patients with newly diagnosed hypothyroidism or 22% if we include all 13 patients. Five of the 58 patients had evidence for an elevation of thyroid hormone binding capacity. Three hypothyroid patients had normal total thyroxins with low thyroid hormone binding ratios. Two euthyroid patients had elevated total T 4 s with low thyroid hormone binding ratio and normal FTI. The prevalence of positive antimicrosomal antibodies was 34%, including 11 euthyroid PBC patients. The prevalence of positive antithyroglobulin antibodies was 20% including five euthyroid patients. There was no association between HLA DR3 or DR5 and the patients with hypothyroidism and/ or antithyroid antibodies. Because fatigue, lethargy, and anorexia as well as hypercholesterolemia are common features of both hypothyroidism and PBC, patients with PBC should be screened for evidence of thyroid dysfunction. Thyroid disease may precede the diagnosis of PBC by several years. Therefore, the development of cholestatic liver disease in a patient with known autoimmune thyroiditis should arouse suspicion of PBC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Matloff DS, Alpert E, Resnick RH, Kaplan MM: A prospective trial ofd-penicillamine in primary biliary cirrhosis. N Engl J Med 306:319–326, 1982

    Google Scholar 

  2. Christensen E, Crowe J, Doniach D, Popper H, Ranek L, Rodes J, Tygstrup N, Williams R: Clinical pattern and course of disease in primary biliary cirrhosis based on an analysis of 236 patients. Gastroenterology 78:236–246, 1980

    Google Scholar 

  3. Tong MJ, Nies KM, Reynolds TB, Quismoro FP: Immunologic studies in familial primary biliary cirrhosis. Gastroenterology 71:305–307, 1976

    Google Scholar 

  4. Sherlock S: Primary biliary cirrhosis. Prog Liver Dis 5:559–574, 1976

    Google Scholar 

  5. Feizi T, Naccarato R, Sherlock S, Doniach D: Mitochondrial and other tissue antibodies in relatives of patients with patient biliary cirrhosis. Clin and Exp Immunol 10:609–622, 1975

    Google Scholar 

  6. Clarke AK: Rheumatic disorders in primary biliary cirrhosis. Ann Rheum Dis 37:42–47, 1978

    Google Scholar 

  7. Schussler G, Schaffner F, Korn F: Increased serum thyroid hormone binding and decreased free hormone in chronic active hepatitis. N Engl J Med 299:510–515, 1978

    Google Scholar 

  8. Crowe JP, Christensen E, Butler J, Wheeler P, Doniach D, Keenan J, Williams R: Primary biliary cirrhosis: The prevalence of hypothyroidism and its relationship to thyroid autantibodies and sicca syndrome. Gastroenterology 78:1437–1441, 1980

    Google Scholar 

  9. Scheuer PJ: Liver Biopsy Interpretation, 2nd ed, Baltimore, Williams & Wilkins, 1973

    Google Scholar 

  10. Lowry RP, Person AE, Goguen JE, Carpenter CB, Garovoy MR: Technical modification for ADCC versus separated T and B lymphocytes: T and B cell separations by nylon wool columns. Transplant Proc 10:833–837, 1978

    Google Scholar 

  11. DHEW Publication No. NIH 76-545, 1976, p 22

  12. Terasaki PI: Histocompatibility testing 1980. Los Angeles, California. UCLA Tissue Typing Laboratory, Regents of the University of California, 1980, pp 962–963

    Google Scholar 

  13. Tunbridge WMG: Screening for thyroid disease in the community. Thyroid Today 5:1–4, 1982

    Google Scholar 

  14. Sawin CT, Chopra D, Azizi F, Mannix JE, Bacharach P: The aging thyroid: Increased prevalence of elevated serum thyroxin levels in the elderly. JAMA 242:247–253, 1979

    Google Scholar 

  15. Moens H, Farid NR: Hashimoto's thyroiditis is associated with HLA-DRW3. N Engl J Med 299:133–134, 1978

    Google Scholar 

  16. Weissel M, Höfer R, Zasmeta H, Mayr WR: HLA-DR and Hashimoto's thyroiditis. Tissue Antigens 16:256–257, 1980

    Google Scholar 

  17. Schneeberg NG, Herman E, Menduke H, Altshuler NK: Reduction of serum cholesterol by sodium dextrothyroxin in euthyroid subjects. Ann Intern Med 56:265–275, 1962

    Google Scholar 

  18. Roitt IM, Doniach D: Human autoimmune thyroiditis: Serological studies. Lancet 2:1027, 1958

    Google Scholar 

  19. Gordin A, Lamberg BA: Natural course of symptomless autoimmune thyroiditis. Lancet 2:1234, 1978

    Google Scholar 

  20. Ingbar SH, Woeber KA: The thyroid gland, Chap. 4.In Textbook of endrocrinology, 5th ed. RH Williams (ed). WB Saunders, 1974

  21. Abreau CM, Vagenakis AG, Roti E, Braverman LE: Clinical evaluation of a hemagglutination method for microsomal and thyroglobulin antibodies in autoimmune thyroid disease. Ann Clin Lab Sci 7:73–78, 1977

    Google Scholar 

Download references

Author information

Author notes

  1. Grace H. Elta MD

    Present address: the Gastroenterology Division, Department of Medicine, University of Michigan, 48109, Ann Arbor, Michigan

  2. Michael J. Goldberg MD

    Present address: Louis A. Weiss Memorial Hospital and Department of Medicine, University of Illinois School of Medicine, Chicago, Illinois

Authors and Affiliations

  1. Gastroenterology Division, Department of Medicine, Tufts-New England Medical Center, 171 Harrison Avenue, Box 233, 02111, Boston, Massachusetts

    Grace H. Elta MD, Robert A. Sepersky MD, Michael J. Goldberg MD, Christine M. Connors, Kenneth B. Miller MD & Marshall M. Kaplan MD

  2. Tissue Typing Laboratory, Brigham and Women's Hospital, 02115, Boston, Massachusetts

    Grace H. Elta MD, Robert A. Sepersky MD, Michael J. Goldberg MD, Christine M. Connors, Kenneth B. Miller MD & Marshall M. Kaplan MD

Authors
  1. Grace H. Elta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert A. Sepersky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael J. Goldberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christine M. Connors
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenneth B. Miller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marshall M. Kaplan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This work was supported by Training Grant AMO7024 and Clinical Study Unit Grant RR 300054 from the National Institutes of Health.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elta, G.H., Sepersky, R.A., Goldberg, M.J. et al. Increased incidence of hypothyroidism in primary biliary cirrhosis. Digest Dis Sci 28, 971–975 (1983). https://doi.org/10.1007/BF01311724

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01311724

Keywords

Search

Navigation