Exp Clin Endocrinol Diabetes 2009; 117(8): 395-399
DOI: 10.1055/s-0029-1202850
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Gallbladder Motor Function in Patients with Different Thyroid Hormone Status

M. Cakir1 , E. Kayacetin2 , H. Toy3 , S. Bozkurt4
  • 1Meram School of Medicine, Division of Endocrinology and Metabolism, Selcuk University, Konya, Turkey
  • 2Meram School of Medicine, Division of Gastroenterology, Selcuk University, Konya, Turkey
  • 3Department of Internal Medicine, Meram School of Medicine, Selcuk University, Konya, Turkey
  • 4Department of Biostatistics and Medical Informatics, School of Medicine, Akdeniz University, Antalya, Turkey
Further Information

Publication History

received 09.04.2008 first decision 30.10.2008

accepted 09.02.2009

Publication Date:
16 April 2009 (online)

Abstract

Hypothyroidism and hyperthyroidism are known to affect cholesterol metabolism, bile acid synthesis and bile content. There are previous studies reporting increased prevalence of gallstone and common bile duct stone formation in hypothyroidism. The aim of this study was to compare gallbladder (GB) motor function between euthyroid, hypothyroid and hyperthyroid subjects by conventional ultrasonography. Eighteen euthyroid, 14 hypothyroid and 20 hyperthyroid, age, sex and body mass index matched subjects were included in the study. Etiology of hypothyroidism comprised of thyroidectomy, Hashimoto's thyroiditis and previous radioactive iodine therapy. Hyperthyroid group included patients with toxic nodular goitre and Graves’ disease. Patients who have diseases or are under drug treatment known to affect biliary function were not included in the study. Fasting and post-stimulus GB volumes were measured by real-time conventional ultrasonography and computer unit (Aloka UST-979, 3.5 mHz electronic convex probe, Japan). No significant differences were noted for fasting, post-stimulus GB volumes and GB ejection fraction between euthyroid, hypothyroid and hyperthyroid subjects. Measuring GB motility accurately is not straightforward because besides being not static during fasting, after a meal, intermittent emptying and refilling of GB occurs. Ultrasonography is affected by GB filling and measures “net” GB emptying. Although cumbersome, additional evaluation with cholescintigraphy which detects “absolute” GB emptying and is not affected by GB filling may provide complete assessment of motor function and may be more informative in evaluating subjects with different thyroid hormone status.

References

  • 1 Andreini JP, Prigge WF, Ma C. et al . Vesicles and mixed micelles in hypothyroid rat bile before and after thyroid hormone treatment: evidence for a vesicle transport system for biliary cholesterol secretion.  J Lipid Res. 1994;  35 1405-1412
  • 2 Behar J, Lee KY, Thompson WR. et al . Gallbladder contraction in patients with pigment and cholesterol stones.  Gastroenterology. 1989;  97 1479-1484
  • 3 Dodds WJ, Groh WJ, Darweesh RM. et al . Sonographic measurement of gallbladder volume.  Am J Roentgenol. 1985;  145 1009-1011
  • 4 Donovan JM. Physical and metabolic factors in gallstone pathogenesis.  Gastroenterol Clin North Am. 1999;  28 75-97
  • 5 Field FJ, Albright E, Mathur SN. Effect of dietary cholesterol on biliary cholesterol content and bile flow in the hypothyroid rat.  Gastroenterology. 1986;  91 297-304
  • 6 Fisher RS, Stelzer F, Rock E. et al . Abnormal gallbladder emptying in patients with gallstones.  Dig Dis Sci. 1982;  27 1019-1024
  • 7 Honore LH. A significant association between symptomatic cholesterol cholelithiasis and treated hypothyroidism in women.  J Med. 1981;  12 199-203
  • 8 Inkinen J, Sand J, Nordback I. Association between common bile duct stones and treated hypothyroidism.  Hepatogastroenterology. 2000;  47 919-921
  • 9 Jazrawi RP, Pazzi P, Petroni ML. et al . Postprandial gallbladder motor function: refilling and turnover of bile in health and in cholelithiasis.  Gastroenterology. 1995;  109 582-591
  • 10 Jazrawi RP. Measurement of gallbladder motor functions: an overview.  Dig Liver Dis. 2003;  35 S51-S55
  • 11 Lanzini A, Lanzarotto F, Baisini O. et al . Value of measuring gallbladder motility in clinical practice.  Dig Liver Dis. 2003;  35 S46-S50
  • 12 Laukkarinen J, Kiudelis G, Lempinen M. et al . Increased prevalence of subclinical hypothyroidism in common bile duct stone patients.  J Clin Endocrinol Metab. 2007;  92 4260-4264
  • 13 Laukkarinen J, Koobi P, Kalliovalkama J. et al . Bile flow to the duodenum is reduced in hypothyreosis and enhanced in hyperthyreosis.  Neurogastroenterol Motil. 2002;  14 183-188
  • 14 Laukkarinen J, Sand J, Aittomäki S. et al . Mechanism of the prorelaxing effect of thyroxine on the sphincter of Oddi.  Scand J Gastroenterol. 2002;  37 667-673
  • 15 Laukkarinen J, Sand J, Saaristo R. et al . Is bile flow reduced in patients with hypothyroidism?.  Surgery. 2003;  133 288-293
  • 16 La Vecchia C, Negri E, D’Avanzo B. et al . Risk factors for gallstone disease requiring surgery.  Int J Epidemiol. 1991;  20 209-215
  • 17 Layden TJ, Boyer JL. The effect of thyroid hormone on bile salt-independent bile flow and Na+, K+ -ATPase activity in liver plasma membranes enriched in bile canaliculi.  J Clin Invest. 1976;  57 1009-1018
  • 18 Lin TH, Rubinstein R, Holmes WL. A study of the effect of D- and L-triiodothyronine on bile acid excretion of rats.  J Lipid Res. 1963;  4 63-67
  • 19 Marzio L. Factors affecting gallbladder motility: drugs.  Dig Liver Dis. 2003;  35 S17-S19
  • 20 Portincasa P, Moschetta A, Colecchia A. et al . Measurements of gallbladder motor function by ultrasonography: towards standardization.  Dig Liver Dis. 2003;  35 S56-S61
  • 21 Prandini N. Methods of measuring gallbladder motor functions – the need for standardization: scintigraphy.  Dig Liver Dis. 2003;  35 S62-S66
  • 22 Stone BG, Ansel HJ, Peterson FJ. et al . Gallbladder emptying stimuli in obese and normal-weight subjects.  Hepatology. 1992;  15 795-798
  • 23 Van Steenbergen W, Fevery J, De Vos R. et al . Thyroid hormones and the hepatic handling of bilirubin. I. Effects of hypothyroidism and hyperthyroidism on the hepatic transport of bilirubin mono- and diconjugates in the Wistar rat.  Hepatology. 1989;  9 314-321
  • 24 Volzke H, Robinson DM, John U. Association between thyroid function and gallstone disease.  World J Gastroenterol. 2005;  11 5530-5534
  • 25 Wasan SM, Sellin JH, Vasilopoulou-Sellin R. The gastrointestinal tract and liver in hypothyroidism. In: Braverman LE, Utiger RD (eds). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text. 9th edn. Philadelphia: Lippincott Williams & Wilkins 2005: 796-803
  • 26 Wasan SM, Sellin JH, Vasilopoulou-Sellin R. The gastrointestinal tract and liver in thyrotoxicosis. In: Braverman LE, Utiger RD (eds). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text. 9th edn. Philadelphia: Lippincott Williams & Wilkins 2005: 589-595
  • 27 Wiley ZD, Lavigne MD, Liu KM. et al . The effect of hyperthyroidism on gastric emptying rates and pancreatic exocrine and biliary secretion in man.  Am J Dig Dis. 1978;  23 1003-1008

Correspondence

M. CakirMD 

Division of Endocrinology and Metabolism

Meram School of Medicine

Selcuk University

42080 Meram

Konya/Turkey

Phone: +90/332/223 77 39

Fax: +90/332/223 61 81

Email: cakirmehtap@yahoo.com

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