Analysis Of Risk Factors And Treatment Strategies Of Liver Injury In Newly Diagnosed Patients With Graves’ Disease

Objective:In this study,we observed the incidence and clinical characteristics of liver injury in newly diagnosed Graves’disease,aiming to analyze the independent risk factors for liver injury,and to explore the therapeutic strategies for newly diagnosed patients with Graves’disease complicated with mild liver injury.Method:Clinical data of patients with Graves’disease newly diagnosed in outpatients and inpatients of the Affiliated Hospital of Qingdao University from January 1,2016 to January 1,2022 were collected,and the basic information,thyroid function,autoantibodies,liver function,treatment methods,and disease outcome of the patients were analyzed.Results:1.According to the inclusion criteria,a total of 522 patients were included in this study,238（45.59%）patients had at least one abnormal liver function index,and 284（54.41%）patients had normal liver function indexes.The female proportion,atrial fibrillation rate,age,FT₃,TPOAb and TRAb levels in the abnormal liver function group were higher than those in the normal liver function group,and the differences were statistically significant（P<0.05）.2.In newly diagnosed patients with liver injury caused by Graves’disease,the incidence rates of abnormal liver function were as follows:ALT（65.55%）,AST（55.46%）,ALP（35.29%）,GGT（21.01%）,TBi L（15.13%）,TP（13.45%）,DBi L（11.76%）,ALB（7.60%）.In the abnormal liver function group,88.24%（210/238）patients showed mild liver dysfunction,and many patients combined with two or more abnormal liver function indexes,but one abnormal liver function index was the most common.3.Multiariable Logistic regression analysis showed that age（OR=1.040,95%CI:1.017～1.063）,FT₃（OR=1.038,95%CI:1.014～1.062）were independent risk factors for liver injury in patients newly diagnosed Graves’disease;Based on the ROC curve of the age,the optimal threshold for age was 41.5 years old,with sensitivity and specificity were57.1%and 66.2%,and the AUC of 0.631（95%CI:0.563～0.698）.Based on the ROC curve FT₃,the optimal threshold of FT3 was 27.825 pmol/L,with sensitivity and specificity were 64.7%and 57.7%,the AUC of 0.628（95%CI:0.561～0.696）.4.In the abnormal liver function group,patients with mild liver with the standardized anti-hyperthyroidism therapy,the efficacy of hepatoprotective drugs followed by anti-hyperthyroidism therapy group（group C）was not significant compared with the antithyroid drugs group（group A）and the hepatoprotective drugs combined with antithyroid drugs group（group B）after 1 month of treatment,and the difference was statistically significant（P<0.05）.However,there was no significant difference in efficacy among the three groups after 3 months of treatment（P>0.05）.Conclusion:1.Liver injury in newly diagnosed patients with Graves’disease is relatively common in clinic,mainly with elevated ALT,and most patients show mild liver dysfunction.2.Logistic regression analysis found that age（OR=1.040,95%CI=1.017～1.063）,FT₃（OR=1.038,95%CI=1.014～1.062）were the independent risk factors of liver injury.For liver injury in patients newly diagnosed Graves’disease Based on the age ROC curve,the optimal age threshold was 41.5 years old,and its sensitivity and specificity were57.1%and 66.2%,Based on the FT₃ROC curve,the optimal threshold of FT₃was 27.825pmol/L,and its sensitivity and specificity were 64.7%and 57.7%.3.For the newly diagnosed patients with mild liver injury of Graves’disease,most of them can gradually return to normal liver function with the improvement of hyperthyroidism.Therefore,standardized antithyroid drug therapy should be actively carried out under the condition of close monitoring of liver function.