EVALUATION of THE RELATIONSHIP BETWEEN THYROID FUNCTIONS and DISEASE OUTCOME in CHILDREN WITH ACUTE LIVER FAILURE

Objective: We investigated if serum TSH, free T4 and free T3 could be prognostic factors in patients with acute liver failure. Materials and Methods: There were 39 out of 108 children with acute liver failure who applied to our hospital between 2000-2017 and whose thyroid function tests were measured at the time of arrival. We retrospectively collected the clinical and laboratory parameters of these 39 patients, and evaluated the relationship between thyroid hormones and prognosis of the patients. Results: TSH levels were low in 29/39 (74.4%) patients, while 27/29 (93.1%) patients had low fT3 levels. Free T4 levels were normal in 25/36 (69.4%) patients. Patients were divided into two groups according to disease course: group 1 (n=17) included patients with spontaneous resolution and group 2 (n=22) included patients who either died or underwent liver transplantation. Total and direct bilirubin levels, INR and PELD values were significantly higher in group 2 compared to the levels of group 1 (p=0.022, p<0.0001, p=0.003, p=0.004, respectively). Serum TSH levels were found to decrease with increasing levels of hemoglobin levels and with increasing stages of encephalopathy, and these correlations were statistically significant (p=0.003, r=-0.464 and p=0.046, r=-0.367, respectively). Serum free T4 levels were found to decrease significantly with decreasing levels of serum albumin levels (p=0.005, r=0.459). Conclusion: Serum TSH and free T3 levels are suppressed in pediatric patients with ALF. Serum TSH levels negatively correlates with increasing stages of encephalopathy, while fT4 levels decrease with decreasing levels of serum albümin