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Assessment of Serum Enzymes Level in Patients with Thyroid Alteration Attending Manipal Teaching Hospital, Pokhara

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Thyroid hormones exert their effect on all tissue and modulate the rate of metabolic activity. Alterations in thyroid function can affect the various organ system of body and perturb measures like AST, ALT, GGT, ALP, CPK and LDH. Both hypothyroidism and hyperthyroidism have potentially fatal systemic manifestations. The main aim of study was to determine the relationship between thyroid alteration and serum enzymes level. The study included 110 subjects visiting Endocrinology Unit of Department of Biochemistry, MTH, Pokhara, with the request of TFT. Thyroid profile and serum enzymes were analyzed using standard kits. Each thirty hyperthyroid and hypothyroid cases show slight elevation of AST, ALT and GGT. However, the values were higher in hyperthyroid subjects. ALP, CPK and LDH were markedly elevated both in hyperthyroidism and hypothyroidism as compared to controls. In conclusion, conducted study demonstrated that there is a positive association between increased serum AST, ALT, GGT, CPK, ALP and LDH in hyperthyroidism and hypothyroidism.
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Research and Reviews: A Journal of Life Sciences
Volume 3, Issue 1, ISSN: 2249-8656
__________________________________________________________________________________________
RRJoLS (2013) 1-9 © STM Journals 2013. All Rights Reserved Page 1
Assessment of Serum Enzymes Level in Patients with
Thyroid Alteration Attending Manipal Teaching
Hospital, Pokhara
Raju Pandey*, Suresh Jaiswal, Jay Prakash Sah, Krishna Bastola, Subadhra Dulal
School of Health and Allied Sciences, Pokhara University, Lekhnath, Nepal
Abstract
Thyroid hormones exert their effect on all tissue and modulate the rate of metabolic activity.
Alterations in thyroid function can affect the various organ system of body and perturb
measures like AST, ALT, GGT, ALP, CPK and LDH. Both hypothyroidism and
hyperthyroidism have potentially fatal systemic manifestations. The main aim of study was to
determine the relationship between thyroid alteration and serum enzymes level. The study
included 110 subjects visiting Endocrinology Unit of Department of Biochemistry, MTH,
Pokhara, with the request of TFT. Thyroid profile and serum enzymes were analyzed using
standard kits. Each thirty hyperthyroid and hypothyroid cases show slight elevation of AST,
ALT and GGT. However, the values were higher in hyperthyroid subjects. ALP, CPK and
LDH were markedly elevated both in hyperthyroidism and hypothyroidism as compared to
controls. In conclusion, conducted study demonstrated that there is a positive association
between increased serum AST, ALT, GGT, CPK, ALP and LDH in hyperthyroidism and
hypothyroidism.
Keywords: thyroid disorders, TSH, FT3, FT4, AST
*Author for Correspondence E-mail: raju_pandey9@yahoo.com
INTRODUCTION
The thyroid is a small butterfly shaped
endocrine gland, located in the lower part of
the neck, in front of the windpipe which
secretes thyroid hormones. The main
hormones released by the thyroid are T3 and
T4; deliver energy to cells of the body [1, 2].
Thyroid hormone synthesis and secretion is
regulated by a negative feedback system that
involves the hypothalamus, pituitary, and the
thyroid gland [2, 4].
Thyroid hormones control the metabolism
the process by which oxygen and calories are
converted to energy for use by the cells and
organs. When the thyroid works normally, it
produces and secretes the amount of T4 and
T3 necessary to keep various body functions
moving at their proper pace [2].
The thyroid frequently is a common target of
disease or dysfunction [2]. Thyroid disorders
are commonly separated into two major
categories, hyperthyroidism (caused by an
overactive thyroid gland) and hypothyroidism
(due to a poorly functioning thyroid gland),
depending on whether serum thyroid hormone
levels (T4 and T3) are increased or decreased,
respectively. Both hypothyroidism and
hyperthyroidism have potentially fatal
systemic manifestations [15].
The symptoms of hyperthyroidism are weight
loss, rapid or irregular heartbeat, anxiety,
irritability, trouble sleeping, trembling in the
hands and fingers, increased sweating,
increased sensitivity to heat, muscle weakness,
etc. The symptoms of hypothyroidism are
weight gain, increased sensitivity to cold,
muscle weakness, joint or muscle pain,
depression, fatigue, pale dry skin, a puffy face,
a hoarse voice, etc. [13].
Subclinical hypothyroidism occurs when TSH
levels are elevated but T3 and T4 levels are
normal [15]. Subclinical hyperthyroidism is
characterized by a low or undetectable
concentration of serum TSH with FT3 and
FT4 levels within laboratory reference ranges
Assessment of Serum Enzymes Level in Thyroid Patients Pandey et al.
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[14]. Euthyroidism refers to the state of
normal functioning of thyroid gland [3]. As
thyroid hormones are essential for normal
organ growth, development, function and
regulate the basal metabolic rate of all cells, its
alteration can affects the entire metabolism [3].
Most affected organs include liver and heart.
So, it alters the liver enzymes like ALP, AST,
ALT, GGT and cardiac enzymes like CPK,
LDH and AST [1, 5, 6].
Therefore, accurate diagnosis of thyroid
abnormalities is critical for clinicians as well
as medical laboratories worldwide for
appropriate management. Laboratory
measurements of T3, T4 and TSH are crucial
in helping clinicians to diagnose thyroid
abnormalities [15].
According to the World Health Organization,
iodine deficiency is the world's most prevalent
yet easily preventable cause of brain
damage. It affects more than 740 million
people worldwide 13% of the world's
population [2]. As many as an additional 30%
of the population worldwide is at risk of iodine
deficiency-related problems. Besides iodine
deficiency, there are number of risk factors
for thyroid disease. These include genetics and
heredity, personal or family, history of
endocrine or autoimmune disease, infection,
exposure to goitrogenic foods, cigarette
smoking, pregnancy, certain drugs, particular
chemical exposures, radiation exposure, and
many other factors. It is estimated that more
than 200 million people at minimum
worldwide have thyroid disease [2].
From the study done in Nepal, it was found
that the prevalence of thyroid dysfunction was
25%. Females have more thyroid dysfunction
than males. Hypothyroidism (8%) and
subclinical hypothyroidism (8%) have higher
prevalence compared to subclinical
hyperthyroidism (6%) and hyperthyroidism
(3%). Higher prevalence of thyroid
dysfunction was observed in subjects with age
above 30 years [7].Based on the comparison
with contemporary studies it is found that
thyrotoxicosis has a significant effect on liver
that is reflected in increased level of liver
specific enzymes i.e., AST, ALT and ALP [1,
8, 9]. In particular, there seems a significant
positive relationship between serum TSH,
ALT and GGT activities throughout the
normal and high TSH ranges, and a similar
inverse relationship between FT4 and serum
liver enzyme activity concentrations [3, 6]. In
another study, serum CPK level shows an
inverse relation with serum T3, T4 levels [5,
1012].
Thyroid dysfunction is one of the major public
health problems in Nepal. Laboratory tests
facilitate early diagnosis before clinical
features are obvious, increased sensitivity
carries the price of decreased diagnostic
specificity. Laboratory tests coupled with
supportive clinical findings are frequently used
to diagnose thyroid dysfunction [15].
MATERIALS AND METHODS
METHODS
The study was conducted in the Department of
Biochemistry laboratory of Manipal Teaching
hospital, Phulbari, Pokhara from July to
December 2011. Fifty apparently healthy
subjects were selected randomly from healthy
volunteers and students from School of health
and Allied sciences and each thirty
hypothyroid and hyperthyroid cases were
selected from the patients visiting MTH. After
selection of the participants and signing of the
consent form, they were interviewed by the
principal investigators by asking the questions
included in the questionnaire. Health screening
of the participants was done using survey
questionnaires.
Study Type
An analytical cross-sectional study was
conducted for 180 days from July to December
2011.
Study Design
The study population included native resident
of Pokhara Valley and surrounding areas and
those who have migrated from other parts of
Nepal. Participants included in this study were
of following religions: Hindu, Buddhist and
Christian; and from different ethnic groups. A
total of 110 individuals participated in the
present study conducted from July to
December 2011.Participants were from
Pokhara valley and from following
surrounding areas: Lekhnath, Kaskikot and
Bharatpokhari VDC. The age range of
participants was 2060 yrs. The objective of
this project was to determine the relationship
Research and Reviews: A Journal of Life Sciences
Volume 3, Issue 1, ISSN: 2249-8656
__________________________________________________________________________________________
RRJoLS (2013) 1-9 © STM Journals 2013. All Rights Reserved Page 3
between serum enzymes level and thyroid
among the apparently healthy and diseased
people of western development region. 50
blood samples were collected from staff of
MTH and students from School of health and
Allied sciences as control. Abnormal 60
samples (30 for hyperthyroidism and 30 for
hypothyroidism) were collected from the
patients visiting MTH. Individuals with an
active infection or a recent infection including
liver disease, bone and muscle disease,
cardiac, pancreatic, hepatobillary, diabetes,
hypertension, malignancy, oral contraceptive
pills (OCP), pregnancy, alcoholics, and drug
abusers were excluded. All the blood samples
were labeled with code number and various
other information including age, sex, location
etc. were also recorded. The samples were
stored in deep freezer until processing.
Inclusion Criteria
The individual within 2060 age groups and
without any chronic condition other than
thyroid are included in this study.
Exclusion Criteria
Individuals with an active infection or a recent
infection including liver disease, bone and
muscle disease, cardiac, pancreatic,
hepatobillary, diabetes, hypertension,
malignancy, oral contraceptive pills (OCP),
pregnancy, alcoholics, and drug abusers were
excluded.
Sample Collection and Laboratory Analysis
5 ml of venous blood was collected from the
selected patients in a plain test tube in Sample
Collection Department of MTH, Pokhara.
Blood collected in plain tube was allowed to
clot at room temperature and then centrifuged
at 1,500 rpm for 5 min. Serum so obtained was
used to determine the thyroid hormones (TSH,
FT3, FT4) and serum enzymes (ALT, AST,
CPK, ALP, GGT, LDH). The final report was
approved by a senior faculty member of the
Biochemistry Department.
Measurement of TSH
It was determined by ELISA method.
Test Principle
The TSH ELISA makes use of highly specific
monoclonal anti-TSH antibody coated on the
surface of the microtiter wells. In the first
incubation step, specimens, calibrators or
controls and enzyme conjugates are mixed to
form the sandwich complex which isbound to
the surface of the wells by the interaction with
immobilized antibody. At the end of the
incubation, excess enzyme conjugate is
washed out. Substrate reagent added and
resulting color, which turns into yellow after
stopping the reaction with stop solution, is
measured photometrically. The intensity of
color is directly proportional to the TSH
concentration in the sample.
Measurement of FT3
It was determined by ELISA method.
Test Principle
ELISA is based on the principle of competitive
binding between FT3 in a test specimen and
T3-peroxidase conjugate for a limited number
of binding sites on the anti-T3 (sheep) coated
well. Thus, the amount of T3- peroxidase
conjugate bound to the well is inversely
proportional to the concentration of FT3 in the
specimen. After incubation of specimen and
T3-peroxidase conjugate unbound enzyme
conjugate is removed in the equilibrium state
by washing. TMB/substrate solution is added
and a blue color develops. The intensity of this
color, which changes to yellow after stopping
reaction, is inversely proportional to the
amount of FT3 in the specimen.
Measurement of FT4
It was determined by ELISA method.
Test Principle
ELISA is based on the principle of competitive
binding between FT4 in a test specimen and
T4-peroxidase conjugate for a limited number
of binding sites on the anti-T4 (sheep) coated
well. Thus, the amount of T4- peroxidase
conjugate bound to the well is inversely
proportional to the concentration of FT4 in the
specimen. After incubation of specimen and
T4-peroxidase conjugate unbound enzyme
conjugate is removed in the equilibrium state
by washing. TMB/substrate solution is added
and a blue color develops. The intensity of this
color, which changes to yellow after stopping
reaction, is inversely proportional to the
amount of FT4 in the specimen.
Assessment of Serum Enzymes Level in Thyroid Patients Pandey et al.
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Measurement of ALT
ALT was determined by Kinetic method.
Test Principle
2-oxoglutarate + L-alanine GPT L-glutamate + pyruvate
Pyruvate + NADH + H+ LDH L-lactate + NAD+
Measurement of AST
AST was determined by Kinetic method.
Test Principle
2-oxoglutarate + L-aspartate GOT L-glutamate + oxaloacetate
Oxaloacetate + NADH + H+ MDH L-malate + NAD+
Measurement of CPK-Nac
CPK-Nac was determined by Kinetic method.
Test Principle
Creatine phosphate + ADP CK Creatine + ATP
Glucose + ATP HK G-6-P + ADP
G-6-P + NADP G-6-P-DH 6-phosphogluconate + NADPH + H+
Measurement of ALP
ALP was determined by Kinetic method.
Test Principle
p-nitrophenyl phosphate + H2O ALP phosphate + p-nitrophenol
Measurement of GGT
GGT was determined by Kinetic method.
Test Principle
L-γ-glutamyl-p-nitroanilide+glycyl glycine GGT L-γ-glutamyl-glycyl glycine + p- nitroaniline
Measurement of LDH
LDH was determined by Kinetic method.
Test Principle
Pyruvate + NADH + H+ LDH L-lactate + NAD+
Statistical Analysis
All the statistical analysis were performed
using SPSS version 17.0 and Microsoft excel
2007. The significant differences between two
groups will be compared using Mann-Whitney
U-test. Pearson’s correlation coefficient will
be determined between hypothyroidism,
hyperthyroidism and control. Data were
presented as mean ± SD. Probability values
were calculated throughout, and p<0.05 was
considered statistically significant. The results
were expressed in the forms of bar diagrams,
and tables, etc.
Research and Reviews: A Journal of Life Sciences
Volume 3, Issue 1, ISSN: 2249-8656
__________________________________________________________________________________________
RRJoLS (2013) 1-9 © STM Journals 2013. All Rights Reserved Page 5
RESULTS
Patients visiting Endocrinology Unit of
Department of Biochemistry, MTH, Pokhara,
with the request of TFT were recruited for the
study. Six variables were measured for
hypothyroidism, hyperthyroidism and controls,
i.e., serum enzymes level ALT, AST, CPK,
GGT, ALK and LDH. Thyroid profile FT3,
FT4 and TSH were measured to categorize
hypothyroidism, hyperthyroidism and controls.
The data were analyzed to compare the mean
values between hypothyroidism,
hyperthyroidism and controls and to find out
correlation between thyroid profile and serum
enzymes in the hypothyroidism,
hyperthyroidism and controls. Overall the
cases and controls were in the age range of
2060 years. About 110 patients were
included. Out of 110 subjects, there were 38
(34.54%) males and 72 females (65.45%) with
mean age 33.13 ± 8.45 and 35.50 ± 10.71,
respectively. In cases, and controls the normal
range of the plasma ALT level is up to 40 U/L
in males and 35 U/L in females, AST level up
to 40 U/L, CPK level from 24 to 195 U/L,
GGT level from 9 to 50 U/L, ALK level is
between 100 and 290 U/L, while LDH level is
from 70 to 240 I/U in both genders. The mean
levels of all the six enzymes were significantly
greater in both hypothyroidism and
hyperthyroidism than in controls (p<0.005).
The normal range for thyroid profile was taken
from the Department of Biochemistry,
MTH. Among the 50 controls the mean FT3,
FT4, and TSH were 2.60 ± 0.62, 1.33 ± 0.27,
and 2.67 ± 1.07, respectively. In hypothyroid
cases, the mean FT3 (1.29 ± 0.56) and FT4
(0.62 ± 0.26) were lower in comparison to
controls whereas, mean TSH (27.97 ± 10.21)
was markedly high. In hyperthyroid cases the
mean FT3 (5.55 ± 1.83), FT4 (2.78 ± 0.61)
were higher compared to controls and
hypothyroids. The mean TSH in hyperthyroid
was 0.16 ± 0.07.
Table 1: Thyroid Profile of the Hypothyroidism, Hyperthyroidism and Control.
Table 2: Serum Enzymes Profile of the Hypothyroidism, Hyperthyroidism and Control.
Study
Group
AST (U/L)
ALT (U/L)
GGT (U/L)
ALP (U/L)
CPK (U/L)
LDH (I/U)
Р value
Control
(n=50)
Mean ±
SD range
29.10±4.26
(19.00-
36.00)
24.88±5.34
(15.00-
35.00)
27.84±6.24
(16.00-
53.00)
178.84±47.73
(100.00-
290.00)
68.82±34.34
(26.00-
167.00)
153.28±36.51
(85.00-
223.00)
<0.005*
Hypothyr
oid
(n=30)
Mean ±
SD range
50.70±8.48
(27.00-
69.00)
46.93±9.64
(32.00-
81.00)
62.26±29.55
(26.00-
150.00)
314.00±144.4
6
(95.00-
600.00)
232.76±102.
03
(17.00-
423.00)
541.06±598.5
3
(184.00-
3654.00)
<0.005*
Hyperthy
roid
(n=30)
Mean ±
SD range
67.80±19.39
(31.00-
111.00)
64.33±31.87
(27.00-
202.00)
82.96±33.15
(30.00-
198.00)
918.43±279.2
3
(512.00-
1550.00)
218.76±60.3
2
(32.00-
350.00)
658.20±458.4
5
(323.00-
2852.00)
<0.005*
*Correlation is significant at the 0.005 level.
Study group
Control
(n=50)
Hypothyroid (n=30)
Hyperthyroid (n=30)
FT3 (pg/ml)
Mean ± SD range
2.60±0.62
(1.60-4.00)
1.29±0.56
(0.393.30)
5.55±1.83
(4.10-11.80)
FT4 (ng /ml)
Mean ± SD range
1.33±0.27
(0.80-1.90)
0.62±0.26
(0.10-1.50)
2.78±0.61
(2.10-4.90)
TSH (IU/ml)
Mean ± SD range
2.67±1.07
(0.70-5.00)
27.97±10.21
(9.0043.20)
0.16±0.07
(0.10-0.30)
Assessment of Serum Enzymes Level in Thyroid Patients Pandey et al.
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In control group, the mean values for AST,
ALT, GGT, ALP, CPK and LDH were
29.10 ± 4.26, 24.88 ± 5.34, 27.84 ± 6.24,
178.84 ± 47.73, 68.82 ± 34.34 and
153.28 ± 36.51, respectively. In hypothyroid
cases AST, ALT and GGT were only slightly
elevated when compared with controls. But
ALP, CPK and LDH were significantly
increased. AST, ALT and GGT were slightly
raised in hyperthyroid subjects whereas ALP,
CPK and LDH show a marked elevation. The
values of AST, ALT and GGT were found
higher than those found in hypothyroids.
Table 3: Correlation Between Serum Enzymes and Thyroid Hormone Profile of the Control.
The above table shows correlation and significance between serum enzymes and thyroid hormones
profile in the control.
Table 4: Correlation Between Serum Enzymes and Thyroid Hormone Profile of the Hyperthyroidism.
The above table shows correlation and significance between serum enzymes and thyroid hormones
profile in the hyperthyroid cases.
Table 5: Correlation Between Serum Enzymes and Thyroid Hormone Profile of the Hypothyroidism.
The above table shows correlation and significance between serum enzymes and thyroid hormones
profile in the hypothyroid cases.
Fig. 1: Graphical Representation of Control and Cases with Serum Enzymes.
SE/TP
AST
ALT
GGT
ALP
CPK
LDH
Correlation
γ
Correlation
γ
Correlation
γ
Correlation
γ
Correlation
γ
Correlation
γ
FT3
0.078
0.006
-0.091
0.110
0.211
0.075
FT4
-0.056
-0.024
0.123
-0.174
-0.111
0.211
TSH
0.186
-0.127
-0.384
0.118
0.114
-0.168
SE/TP
AST
ALT
GGT
ALP
CPK
LDH
Correlation
γ
Correlation
γ
Correlation
γ
Correlation
γ
Correlation
γ
Correlation
γ
FT3
0.388
0.130
-0.096
-0.104
-0.479
-0.134
FT4
0.175
-0.011
0.058
-0.262
-0.517
-0.021
TSH
0.185
0.203
0.305
0.278
0.284
0.272
SE/TP
AST
ALT
GGT
ALP
CPK
LDH
Correlation
γ
Correlation
γ
Correlation
γ
Correlation
γ
Correlation
γ
Correlation
γ
FT3
-0.386
-0.320
0.298
0.154
0.072
-0.036
FT4
-0.159
-0.212
0.325
-0.095
0.086
0.100
TSH
-0.009
-0.026
0.212
-0.145
0.063
-0.106
= Euthyroid
= Hyperthyroid
= Hypothyroid
Research and Reviews: A Journal of Life Sciences
Volume 3, Issue 1, ISSN: 2249-8656
__________________________________________________________________________________________
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DISCUSSION
Present study of 110 subjects was conducted to
assess serum enzymes level in thyroid
alteration is probably the first epidemiological
study carried out in Western Development
Region, Nepal.
Serum enzymes profile have been proved
valuable as diagnostic and prognostic
guideline both in clinical practice and
occupational medicine; reflecting the status,
size, structure and functions of different body
organs affected by age, sex, environmental
factors, various diseases and drugs.
In the study, it was found that the prevalence
of thyroid dysfunction was 25%. Females have
more thyroid dysfunction than males. In
majority of the cases diagnosis is usually
straightforward on clinical grounds. However,
various diagnostic tests are performed for
confirmation of the disease, i.e., Serum FT3,
FT4 and TSH levels. It is well known that
various organs biochemical abnormalities have
been shown in patients with thyroid alteration
[28, 29].
In the present study, 50 blood samples were
collected from staff of MTH and students from
School of health and Allied sciences as
control. Abnormal 60 samples (30 for
hyperthyroidism and 30 for hypothyroidism)
were collected from the patients visiting MTH
and examined for their serum levels of
enzymes ALT, AST, CPK, ALK, GGT and
LDH. The serum reports of thyroid hormones
FT3, FT4 and TSH were already available
with the cases (hypothyroidism and
hyperthyroidism), while these tests were
performed for the controls.
Since, no previous data were available from
the area under study, the observed serum
enzymes profile was compared with normal
standard and correlated with thyroid hormones
profile in cases and controls. Results of the
study from the MTH did not differ
significantly from other studies and have been
found in conformity with previous works
carried out by various scientists. Therefore,
results of the study from MTH shows an
unexplained relationship between serum
thyroid hormones and serum enzymes level in
thyroid alteration. Malik and Hodgson
reviewed the relationship between thyroid
gland and liver in hyperthyroidism [14]
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 all the organ function. The liver,
muscle and kidney in turn metabolizes thyroid
hormones and regulates their systemic
endocrine effects. Therefore, thyroid
dysfunction may disturb liver, muscle, other
organs function and vice versa. It highlights a
close relationship between thyroid and various
organs in health and disease. The clinical
features of liver injury caused by
thyrotoxicosis are relatively common and can
be conveniently divided into hepatic and
cholestatic types. In hepatic injury an increase
in levels of AST and ALT were reported in
27% and 37% of the patients, respectively.
Although majority of them showed no other
clinical or biochemical features of liver
impairment. The mechanism of injury appears
to be relative hypoxia in periventricular
regions of the liver, due to an increase in
hepatic oxygen demand without an appropriate
increase in blood flow.
Therefore, results of the present study along
with the earlier reports are suggestive of the
fact that more the serum thyroid hormones
level is elevated, higher is the serum enzymes
(ALT, AST, CPK, GGT, ALP and LDH) level.
Thus, showing a positive relationship between
FT3, FT4 and ALT, AST, CPK, ALK, GGT
and LDH levels, this is in accordance with the
values reported in the previous studies. The
relationship between thyroid hormones and
serum enzymes levels have been well
documented, though its importance as other
organs dysfunction is still controversial.
Findings of the present study are consistent
with the previous work regarding elevated
plasma serum enzymes levels in thyroid
alteration. But contrary to the expectations, the
correlation between thyroid and serum
enzymes profile was found to be non
significant which is in agreement with
previous studies. Regardless of the reasons,
significant alteration in serum enzymes in
hypothyroidism and hyperthyroidism was not
seen in enough individuals to make us feel
Assessment of Serum Enzymes Level in Thyroid Patients Pandey et al.
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RRJoLS (2013) 1-9 © STM Journals 2013. All Rights Reserved Page 8
comfortable in using it as a reliable tool for
diagnosis and prognosis of the disease.
In hypothyroid cases, the serum enzymes
AST, ALT and GGT were only slightly
increased whose mean values were less than
those found in hyperthyroidism. Other serum
enzymes CPK, ALP and LDH showed a
marked elevation. Thus, study clearly revealed
a positive association between increased serum
AST, ALT, GGT, CPK, ALP and LDH in
hyperthyroidism and hypothyroidism.
CONCLUSION
The present study ascertained that thyroid
disorder causes significant effect on
metabolism of various cells of the body that
was reflected by increased level of serum
enzymes to a varying extent. Thyroid
dysfunction shows a strong female
preponderance in Pokhara valley. This was an
analytical cross-sectional study carried out in
110 subjects visiting Endocrinology Unit of
Department of Biochemistry, MTH, Pokhara,
with the request of TFT. Author’s study Group
was divided into euthyroid, hyperthyroid and
hypothyroid. Since, there have been no such
studies on the determination of serum enzymes
level in this study area before, authors found it
likely that thepopulation in this respect
represents that of Nepal. From the study, it is
clear that thyroid hormones have significant
effect on various organ systems of the body.
During thyroid alteration, serum enzymes
levels were also fluctuated. In hyperthyroid
cases, the serum enzymes AST, ALT, GGT
and CPK were slightly elevated with mean
values 67.80 ± 19.39, 64.33 ± 31.87,
82.96 ± 33.15 and 218.76 ± 60.32, respectively
whereas, ALP and LDH shows significant
elevation when compared to the controls.
In hypothyroid cases, the serum enzymes
AST, ALT and GGT were only slightly
increased whose mean values were less than
those found in hyperthyroidism. Other serum
enzymes CPK, ALP and LDH showed a
marked elevation. Thus, study clearly revealed
a positive association between increased serum
AST, ALT, GGT, CPK, ALP and LDH in
hyperthyroidism and hypothyroidism. Based
on the results, it can be concluded that this
association could lead us to newer avenues to
investigate the pathophysiology and
management of patients with mild to moderate
abnormalities of relative organs or systems.
Therefore, it necessitates the measurement of
thyroid hormones in patients with abnormal
serum enzymes level without any significant
cause. However, further studies are required to
be carried out in large sample size to confirm
our findings.
LIMITATIONS
Author’s study was a hospital based cross-
sectional study involving small number of
patients visiting a single hospital in
Pokhara. Therefore, the observation might
not be true representative of the thyroid
disease patients in Western Region.
TSH, FT3 and FT4 were only determined
to classify thyroid disorders excluding
others.
AST, ALT, ALP, GGT LDH, CPK were
only determined excluding other serum
enzymes.
Sample size was only for 110 patients.
Due to the limitation of time, authors
couldn’t include other organs marker to
determine their extent of dysfunction.
Though the most recent specific and
sensitive method for the estimation of
thyroid function is chemiluminescence
method, authors had used microtiter well
ELISA in this research.
However, electricity, space, water supply,
semi-automated analyzer and common
glassware will be provided by the
Biochemistry Department of Manipal
Teaching Hospital.
FUTURE PERSPECTIVES
Government should initiate and promote a
routine screening program for thyroid
alteration and its effect on other organs.
Future studies are also needed to evaluate
the general population and to trace the
subjects under risk for development of
multi organ dysfunction due to thyroid
alteration.
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... Our results reflected that the prevalence of Thyroidism was high in younger individuals (20-40 years of age). Many studies revealed the high prevalence of Thyroidism was found to occur more frequently in this age group [16,22]. Furthermore, in Pakistan, the female is more likely to be affected with hypothyroid than males and most frequently developed in the adult age between 20-35 years [23,24]. ...
... Furthermore, in Pakistan, the female is more likely to be affected with hypothyroid than males and most frequently developed in the adult age between 20-35 years [23,24]. The high ratio of Thyroidism in adults maybe because of the reproduction ability and hyperactivity of reproductive hormones [22]. Iodine deficiency is one of the fundamental reasons for the high ratio of Thyroidism, particularly in South Asian countries. ...
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The thyroid gland is a major endocrine gland. Subclinical hypothyroidism and hyperthyroidism are common health issue particularly in the developing and if remain untreated can manifest serious health consequences. The aim of this study was to figure out the current situation of subclinical thyroid disease in the Pakistani and Afghan refugees living in Quetta city. For this purpose different public sector hospitals were visited on regular bases from October 2018 to October 2019 to find out the prevalence of this disease. Subclinical hypo and hyperthyroid patients of both the nationalities age among 20-70 years were enrolled. Furthermore, the prevalence of clinical sign and symptoms related to thyroidal dysfunction, the physical activities of the patients, use of iodized/non-iodized salt, feeding habit was also recorded. To confirm the status of hypothyroidism and hyperthyroidism the thyroid functional test (TFT) was performed by using Radio Immuno Assay (RIA). Our data showed that the prevalence of Thyroidism was higher in females than males both in Pakistani and Afghani patients. The overall prevalence of euthyroid was (21.66%), hypothyroidism (45.83%) and hyperthyroid (32.52%), thus the prevalence of hypothyroidism was found to be higher than hyperthyroidism and this prevalence was high in the patients among 20-45 years of age. Furthermore, the prevalence data related to clinical sign showed that weight gain (82.12%), cold intolerance (79.60%) and anxiety (74.34%) was more common in hypothyroid patients whereas, weight loss (84.23%), goiter (79.13%) and increase heart rate (78.51%) were the common issues in hyperthyroid patients.
... Thyroid hormones are crucial for growth and for the regulation of protein, carbohydrate and fat metabolism. 1 Thyroid disorders are commonly divided into two major categories, hyperthyroidism and hypothyroidism, depending on whether serum thyroid hormone levels (T4 and T3) are increased or decreased respectively. 2 The symptoms of hyperthyroidism are weight loss, rapid or irregular heartbeat, anxiety, irritability, trouble sleeping, trembling in the hands and fingers, increased sweating, increased sensitivity to heat, muscle weakness, etc. ...
... FIGURE 2). The findings of our study is in corroboration with findings of the study byKalita N et al 6 , Yadav A. et al. 7 , p.d Griffiths et al 8 and Pandey R. et al.1 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. ...
... Our results reflected that the prevalence of Thyroidism was high in younger individuals (20-40 years of age). Many studies revealed the high prevalence of Thyroidism was found to occur more frequently in this age group [16,22]. Furthermore, in Pakistan, the female is more likely to be affected with hypothyroid than males and most frequently developed in the adult age between 20-35 years [23,24]. ...
... Furthermore, in Pakistan, the female is more likely to be affected with hypothyroid than males and most frequently developed in the adult age between 20-35 years [23,24]. The high ratio of Thyroidism in adults maybe because of the reproduction ability and hyperactivity of reproductive hormones [22]. Iodine deficiency is one of the fundamental reasons for the high ratio of Thyroidism, particularly in South Asian countries. ...
... The declining level of serum ALP among hypothyroid patients in the current study agrees with the finding of Mane and Bhagwat [18] and Al-Hindawi et al. [19], which mentioned that ALP values in hypothyroid were significantly lower compared to control. Another study made by Pandey et al. [20] showed a significant increase in serum ALP level in hypothyroidism. The reduction in blood ALP activity in hypothyroid individuals may be due to low serum magnesium and zinc levels; restoring serum magnesium and zinc levels to normal also restored serum ALP activity to normal; or it may be due to reduced ALP synthesis by osteoblasts, which needed thyroid hormones. ...
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... Hekimsoy Z h et al 10 in their study observed normal CK levels in subclinical hypothyroidism and controls, high CK levels in overt hypothyroidism. Few authors have observed significant increase in CK levels [10][11][12][13][14][15][16] and both 17 CK and LDH in their study population. ...
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... Both hyperthyroidism and hypothyroidism have potentially fatal systemic manifestations such as liver or heart failure. [3] Graves Thyroid disorders often appear as abnormal level in serum enzymes or disturbances in liver functions. The major difficulty in diagnosis is subclinical hypo/hyperthyroidism. Which are common disorders traditionally detected by an imbalance of thyroid hormone levels, in particular, TSH. ...
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The liver has an important role in thyroid hormone metabolism and the level of thyroid hormones is also important to normal hepatic function and bilirubin metabolism. Besides the associations between thyroid and liver diseases of an autoimmune nature, such as that between primary biliary cirrhosis and hypothyroidism, thyroid diseases are frequently associated with liver injuries or biochemical test abnormalities. For example, thyroid diseases may be associated with elevation of alanine aminotransferase and alkaline phosphatase, which is mainly of bone origin, in hyperthyroidism and aspartate aminotransferase in hypothyroidism. Liver diseases are also frequently associated with thyroid test abnormalities or dysfunctions, particularly elevation of thyroxine-binding globulin and thyroxine. Hepatitis C virus infection has been connected with thyroid abnormalities. In addition, antithyroid drug therapy may result in hepatitis, cholestasis or transient subclinical hepatotoxicity, whereas interferon (IFN) therapy in liver diseases may also induce thyroid dysfunctions. These thyroid-liver associations may cause diagnostic confusions. Neglect of these facts may result in over of under diagnosis of associated liver or thyroid diseases and thereby cause errors in patient care. It is suggested to measure free thyroxine (FT4) and thyroid-stimulating hormone (TSH) which are usually normal in euthyroid patients with liver disease, to rule out or rule in coexistent thyroid dysfunctions, and consider the possibility of thyroid dysfunctions in any patients with unexplained liver biochemical test abnormalities. It is also advisable to monitor patients with autoimmune liver disease or those receiving IFN therapy for the development of thyroid dysfunctions, and patients receiving antithyroid therapy for the development of hepatic injuries.
Article
Thyroid hormones exert their effect on all tissue and modulate the rate of metabolic activity appropriate for each situation. As a result of their actions, alterations in thyroid function can affect the liver and perturb measures of hepatic function and injury in the absence of liver disease. These alterations in the measure of hepatic function and injury may be difficult to recognize as being caused by thyroid dysfunction rather than hepatic disease. As a result, they may be quite troublesome for patients and physicians if their cause is not properly identified. Importantly, abnormalities in liver function tests return to normal once the primary thyroid pathology is recognized and treated.
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Serum creatine phosphokinase activity was determined in euthyroid, hyperthyroid and hypothyroid subjects. Mean serum enzyme values (μmol substrate converted/ml/hr) were: 2.03 (±0.216) for healthy subjects, 1.71 (±0.257) for euthyroid patients, 0.72 (±0.08) for hyperthyroid patients and 13.22 (±3.22) for hypothyroid patients. Serial studies in hyper- and hypothyroidism demonstrated good correlation of serum enzyme activity with thyroid function. The assay of this enzyme was found to be useful in the assessment of thyroid status in patients who received exogenous iodine or diphenylhydantoin. Concurrent injury or inflammatory disease of skeletal or cardiac muscle invalidates the diagnostic value of CPK in hypothyroidism but increases its usefulness in hyperthyroidism.