RELATIONSHIP BETWEEN ULTRASOUND CHANGES IN THE LIVER AND HYPOTHYROIDISM IN PATIENTS WITH AUTOIMMUNE THYROIDITIS
Authors: Lavruk K. Z. , Dudiy P. F. , Skrypnyk N. V. , Vytvytskyi Z. Ya. 
Published: October 2022

Hashimoto's autoimmune thyroiditis (AIT) is one of the most frequent causes of hypothyroidism, which leads to the development of dysfunctions of various body systems. Since the hepatobiliary system is closely related to the thyroid gland, a decrease in thyroid function is considered one of the factors in the development of non-alcoholic fatty liver disease. Early detection of changes in the liver in patients with hypothyroidism makes it possible to start therapy in time and prevent the development of complications, such as fatty dystrophy, inflammation, damage to hepatocytes, fibrosis, cirrhosis.

The aim. Determine the relationship between hypothyroidism and ultrasound changes in the liver in patients with AIT.

Methods. 62 patients with AIT and hypothyroidism were examined. The first group included 32 patients with a history of AIT up to two years, the second group included 30 patients with a history of the disease for more than two years, and the control group included 30 patients without signs of thyroid pathology. Thyroid function was assessed based on the results of a hormone levels blood test. Multiparametric ultrasound examination of the liver and thyroid gland was performed on Siemens Acuson S2000 and S3000 devices in B-mode, color doppler mapping, pulse-wave doppler and shear-wave elastography (SWE) modes.

Results. Ultrasound changes in the liver were more often observed in patients with subclinical hypothyroidism on the background of AIT. It was found that the number of patients with sonographic signs of liver damage is greater in the second group than in the first. Sonographic signs of the hepatobiliary system damage included an increase in the size of the liver, an increase in the echogenicity of its parenchyma, not homogeneous structure and dilatation of the portal vein.

The analysis of the level of shear wave speed in the parenchyma of the thyroid gland showed that it was higher in second groups and its increase was also noted in patients with subclinical and clinical hypothyroidism.

The results of SWE of the liver demonstrated a positive correlation between the stiffness of the liver parenchyma and the duration of AIT. Also, significantly higher values of SWE were observed in patients who, at the time of examination, had laboratory signs of thyroid dysfunction and the high level of shear wave velocity in the thyroid gland parenchyma. The analysis of the number of cases of liver fibrosis in two groups showed that it is more often detected during the long course of the disease. The percentage of patients with F1-F2 in the first group was 32% and in the second group - 53%.

Conclusions. The established relationship between sonographic signs of diffuse changes in the liver parenchyma and hypothyroidism determines the expediency of using multiparametric ultrasound examination of the hepatobiliary system in patients with AIT to assess its condition, early diagnosis of fibrosis and determine the need for correction of treatment tactics.