medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-15-88-94medsovet-6432Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERПричинно-следственная связь патологии щитовидной железы и печениCause-and-effect relationship between thyroid and liver diseaseshttps://orcid.org/0000-0002-5041-3466БуеверовА. О.BueverovA. O.

д.м.н., профессор кафедры медико-социальной экспертизы, неотложной и поликлинической терапии Института профессионального образования; ведущий научный сотрудник отделения гепатологии

119991,  Москва, ул. Трубецкая, д. 8, стр. 2; 129110,  Москва, ул. Щепкина, д. 61/2, корп. 1. 

Dr. Sci. (Med.), Professor of the Department of Medical and Social Expertise, Emergency and Outpatient Therapy, Institute of Professional Education; Lead Researcher, Department of Hepatology

8, Bldg. 2, Trubetskaya St., Moscow, 119991;  61/2, Bldg. 1, Schepkin St., Moscow, 129110

bcl72@yandex.ruhttps://orcid.org/0000-0003-2346-1216БогомоловП. О.BogomolovP. O.

к.м.н., научный руководитель отделения гепатологии

129110,  Москва, ул. Щепкина, д. 61/2, корп. 1. 

Cand. Sci. (Med.), Scientific Director of  the  Department of  Hepatology

 61/2, Bldg. 1, Schepkin St., Moscow, 129110

https://orcid.org/0000-0001-8288-410XНечаеваО. А.NechayevaO. A.

к.м.н., старший научный сотрудник отделения эндокринологии

129110,  Москва, ул. Щепкина, д. 61/2, корп. 1. 

Olga A. , Cand. Sci. (Med.), Senior Researcher Department of Endocrinology

61/2, Bldg. 1, Schepkin  St., Moscow, 129110

olga1185@yandex.ruhttps://orcid.org/0000-0003-3494-8011ЗиловА. В.ZilovA. V.

к.м.н., доцент кафедры эндокринологии №1 Института клинической медицины

119991,  Москва, ул. Трубецкая, д. 8, стр. 2

Cand. Sci. (Med.), Associate Professor Department of Endocrinology No. 1, Institute of Clinical Medicine

8, Bldg. 2, Trubetskaya St., Moscow, 119991

avzilov@hotmail.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); Московский областной научно-исследовательский клинический институт имени М.Ф. Владимирского, Фонд поддержки и развития доказательной медициныРоссияSechenov First Moscow State Medical University (Sechenov University); Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Evidence-Based Medicine Support and Development FundRussian FederationМосковский областной научно-исследовательский клинический институт имени М.Ф. Владимирского, Фонд поддержки и развития доказательной медициныРоссияMoscow Regional Research Clinical Institute named after M.F. Vladimirsky, Evidence-Based Medicine Support and Development FundRussian FederationМосковский областной научно-исследовательский клинический институт имени М.Ф. Владимирского, Фонд поддержки и развития доказательной медициныРоссияMoscow Regional Research Clinical Institute named after M.F.  Vladimirsky, Evidence-Based Medicine Support and Development FundRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical UniversityRussian Federation2021171020210158894Copyright © Буеверов А.О., Богомолов П.О., Нечаева О.А., Зилов А.В., 20212021Буеверов А.О., Богомолов П.О., Нечаева О.А., Зилов А.В.Bueverov A.O., Bogomolov P.O., Nechayeva O.A., Zilov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6432

Щитовидная железа и печень находятся в сложных взаимоотношениях как в физиологических, так и в патологических условиях. Тиреоидные гормоны ускоряют метаболические процессы, интенсифицируют синтез белков и витаминов, играют важную роль в развитии и дифференцировке всех клеток, в т. ч. гепатоцитов. Помимо центральной роли в дейодировании тиреоидных гормонов с образованием их более активных и инактивированных форм, печень также осуществляет их транспорт. Нарушения функции ЩЖ могут приводить к изменениям функции печени, а при заболеваниях печени могут возникать отклонения в метаболизме тиреоидных гормонов. Наиболее часто патология печени при болезнях ЩЖ проявляется повышением сывороточной активности ферментов цитолиза и/или холестаза. Изменения функциональных печеночных тестов нередко наблюдаются при тиреотоксикозе. В их основе лежат окислительный стресс либо холестаз. Повышенная активность остеобластов при гипертиреозе обусловливает повышение костной фракции щелочной фосфатазы, что необходимо учитывать при дифференциальном диагнозе. Относительно часто регистрируется гепатотоксичность тиреостатических препаратов, варьирующаяся от минимального гепатоцеллюлярного повреждения до фульминантной печеночной недостаточности. В случае гипотиреоза патофизиологические механизмы представлены преимущественно нарушениями липидного обмена, ведущими к  жировой дистрофии. Следует помнить, что тяжелый гипотиреоз может проявляться гипераммониемией и отечно-асцитическим синдромом, требующими дифференциальной диагностики, с печеночной недостаточностью. Лечение патологии печени при заболеваниях ЩЖ заключается в нормализации тиреоидного статуса, а в случаях лекарственного гепатита – своевременной отмене потенциально гепатотоксического препарата. Весьма интересны данные об ассоциации гипотиреоза и неалкогольной жировой болезни печени в аспекте разработки новых методов терапии.

Thyroid gland (TG) and the liver are in a complex relationship in both physiological and pathological conditions. Thyroid hormones accelerate metabolic processes, intensify the synthesis of proteins and vitamins, play an important role in the development and differentiation of all cells, including hepatocytes. In addition to the central role in the deiodination of thyroid hormones with the formation of their more active and inactivated forms, the liver also carries out their transport. Dysfunction of TG can lead to changes in liver function, and in liver diseases, abnormalities in the metabolism of thyroid hormones can occur. Most often, liver pathology in diseases of TG is manifested by an increase in the serum activity of enzymes of cytolysis and/or cholestasis. Changes in liver function tests are often observed in patients with thyrotoxicosis. They are based on oxidative stress or cholestasis. The increased activity of osteoblasts in hyperthyroidism leads to an increase in the bone fraction of alkaline phosphatase, which must be taken into account in the differential diagnosis. Hepatotoxicity of thyreostatic drugs is relatively common, ranging from minimal hepatocellular damage to fulminant liver failure. In the case of hypothyroidism, the pathophysiological mechanisms are mainly represented by lipid metabolism disorders leading to fatty degeneration. It should be remembered that severe hypothyroidism can be manifested by hyperammonemia and edematous-ascitic syndrome, requiring differential diagnosis with liver failure. Treatment of liver pathology in TG diseases includes normalization of thyroid status, and in cases of drug hepatitis – temporary withdrawal of a potentially hepatotoxic drug. The data on the association of hypothyroidism and non-alcoholic fatty liver disease in the aspect of developing new therapies are very interesting.

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The authors declare that there are no conflicts of interest present.