Liver Function in Thyrotoxicosis: With Special Reference to the Results of Liver Function Tests in Patients under Treatment with Thiouracil

Allison, Andre (1949) Liver Function in Thyrotoxicosis: With Special Reference to the Results of Liver Function Tests in Patients under Treatment with Thiouracil. PhD thesis, University of Glasgow.

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That in cases of thyrotoxicosis which come to autopsy there is an unusually high percentage which show evidence of liver damage is undoubted from the numerous reviews of the subject already quoted. In the average case of thyrotoxicosis met with clinically evidence of hepatic damage may be found in a high proportion by means of liver function tests. The degree of impairment is on the average only slight and in the great majority of cases responds rapidly to the control of the disease with thiouracil. Certain patients however show further impairment of liver function under treatment and the possible reasons for this have been considered. There has been difficulty in correlating the results of liver function tests with the appearances of the organ found at aspiration biopsy and the significance of the positive results of the tests used in this investigation have been discussed from this viewpoint. It would appear that positive results may be obtained in hyperthyroidism not only as a result of actual liver damage but also from a number of associated factors. The oral hippuric acid test may be impaired on account of competition for glycine for metabolic needs. The flocculation reactions may be complicated by changes occurring in the plasma proteins as a result of the toxic action of thyroid hormone, a condition of partial starvation or infective processes. The precise part which each of these factors may play will have to await the results of more detailed analysis of the factors/ factors causing precipitation and the precise significance of such changes in the conditions in which they have been noted. Supporting evidence has been produced to show that as had been suggested when liver damage does occur it is probably due to a relative nutritional deficiency of such substances as cystine, methionine and tocopherol which has arisen as the result of the increased metabolism. This being largely a question of balance will be influenced by such factors as the patients appetite and his economic position to satisfy it. The rather higher incidence noted in this series than by certain American writers may be due to the system of food rationing in this country and the inability of the patient to secure an adequate amount of food, particularly protein to satisfy his needs. In individual cases liver damage may be aggravated by anaemia, anoxaemia, chronic venous congestion or the action of drugs such as anaesthetics used at operation. No particular clinical value appears to be attached to one or all of the tests employed in this investigation. As far as preparation of the patient for operation is concerned, if adequate thiouracil therapy be employed to reduce the metabolic rate to near normal limits and the patient is showing a satisfactory gain in weight postoperative complications are unlikely to develop even in the presence of poor liver function tests.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Medicine, Toxicology
Date of Award: 1949
Depositing User: Enlighten Team
Unique ID: glathesis:1949-79715
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 31 Mar 2020 09:09
Last Modified: 31 Mar 2020 09:09

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