Clinical and laboratory characteristics of patients with thyroid diseases with and without alanine aminotransferase levels above the upper tertile – Cross-sectional analytical study

Objective Thyroid disease affects 6.6% of the general population. The liver is fundamental in metabolizing thyroid hormones, and hepatocytes are often affected in thyroid disease. We aimed to compare clinical and laboratory parameters among thyroid disease patients with alanine aminotransferase (ALT) levels above vs. below the upper tertile. Subjects and methods A retrospective cross-sectional analytical study was conducted in the endocrinology clinic at Polydoro Ernani de São Thiago University Hospital. Patients with thyroid disease between August 2012 and January 2014 were included in the study. Clinical and laboratory parameters were collected from medical records. Results One hundred patients were included, of which 14.0% were male, with a mean age of 49.1 ± 14.4 years. ALT levels ranged from 9 to 90 U/L, and the ALT upper tertile was defined as 0,64 times the upper normal limit (xUNL). Patients with ALT levels above the upper tertile exhibited a higher proportion of systemic arterial hypertension (SAH), a higher mean abdominal circumference and a higher frequency of elevated TSH levels than did patients with ALT levels below the upper tertile. In multivariate analysis, ALT ≥ 0.64 (xUNL) was independently associated with abdominal circumference (odds ratio [OR] = 0.087, 95% confidence interval [CI] 0012-0167, P = 0.022). ALT (xUNL) correlated positively with total cholesterol (r = 0.213, P = 0.042). Conclusions In patients with thyroid diseases, it was observed that those with ALT above the upper tertile are associated with abdominal circumference and ALT levels correlate with total cholesterol.

El efecto de la dieta libre de gluten en la alanina-aminotransferasa (ALT) en pacientes celíacos / The effect of a gluten-free diet on alanine aminotransferase (ALT) in celiac patients

Introducción: la enfermedad celíaca es una enfermedad autoinmune provocada por la ingestión de gluten que afecta aproximadamente al 0,5%-1% de la población mundial. Las señales extraintestinales incluyen elevados niveles de alanina-aminotransferasa (ALT). Objetivo: evaluar los efectos de una dieta libre de gluten en los niveles ALT en pacientes con enfermedad celíaca. Métodos: este estudio transversal se llevó a cabo en la clínica ambulatoria de gastroenterología de un hospital universitario. Resultados: se incluyeron veintiséis pacientes con enfermedad celíaca con edad de 34,1 ± 11,4 años; 15,4% fueron hombres. Los sujetos del estudio tenían un nivel promedio de ALT de 54,6 ± 36,3 (mediana 40,5) U/L. Hubo una mayor proporción de individuos con hepatitis B en el grupo con ALT ≥50 U/L en comparación con sujetos con ALT <50 U/L. Entre los pacientes evaluados después del tratamiento con dieta libre de gluten se observó una reducción significativa de los valores de ALT (36,0 versus 31,0 U/l; p= 0,008). Conclusión: el treinta y cinco por ciento de los pacientes con enfermedad celíaca tenía ALT por encima del tercil superior. Se encontraron niveles más altos de ALT en pacientes con hepatitis viral B y en aquéllos que no se adhirieron a la dieta. Hubo una reducción de aminotransferasas como resultado de una dieta libre de gluten.

Introduction: Celiac disease is an autoimmune disease triggered by ingestion of gluten. It affects approximately 0.5% to 1% of the world population. Extra intestinal manifestations include elevated alanine aminotransferase (ALT) levels. Objective: The objective of this study was to evaluate the effects of a gluten-free diet on ALT levels in patients with celiac disease. Methods: This cross-sectional study was conducted in the gastroenterology outpatient clinic of a university hospital. Results: Twenty-six patients with celiac disease were included. Average patient age was 34.1 ± 11.4 years, and 15.4% of the patients were men. Study subjects had a mean ALT level of 54.6 ± 36.3 U/L (median 40.5). There was a higher proportion of individuals with hepatitis B in the group with ALT ≥ 50 U/L than in the group of subjects with ALT < 50 U/L. Among patients tested after treatment with a gluten-free diet, we observed a significant reduction in ALT values (36.0 vs. 31.0 U/L; P = 0.008). Conclusion: Thirty-five percent of celiac disease patients had ALT levels above the upper tertile. Higher ALT levels were found in patients with viral hepatitis B and in those who do not adhere to the diet. There was a reduction of aminotransferases with a gluten-free diet.