Original articlePancreas, biliary tract, and liverSubclinical Hypothyroidism and Low-Normal Thyroid Function Are Associated With Nonalcoholic Steatohepatitis and Fibrosis
Section snippets
Subjects and Study Design
In this study, we analyzed data from a previously described cohort.17 Briefly, we enrolled eligible subjects from the Boramae NAFLD cohort (NCT02206841) from January 2013 to January 2017. The eligibility criteria for this cohort were as follows: 1) ≥18 years of age; 2) ultrasonography-diagnosed fatty liver (increased liver/kidney echogenicity and posterior attenuation); and 3) unexplained high alanine aminotransferase (ALT) levels above the reference range within the past 6 months.18 We
Baseline Characteristics in Subjects With Low-Normal Thyroid Function or Subclinical Hypothyroidism Compared With Those With Strict-Normal Thyroid Function
Among the 425 subjects (mean age, 53 years; 52% men) with biopsy-proven NAFLD, 282 subjects were classified in the strict-normal thyroid function group, 84 in the low-normal thyroid function group, and 59 in the subclinical hypothyroidism group. The baseline characteristics of this cohort are shown in Table 1. With regard to age and gender, the groups were similar. The BMI, waist circumference, serum ALT level, aspartate aminotransferase (AST) level, HOMA-IR, and prevalence of current smoking
Discussion
We report a strong association of biopsy-proven NASH or associated advanced fibrosis with increasing plasma TSH levels in a dose-dependent manner even within the normal clinical ranges of T4 as our main finding. The prevalence of NASH and advanced fibrosis was significantly higher in subjects with subclinical hypothyroidism than in those with normal thyroid function. These findings suggest that higher TSH levels even within the normal range are closely associated with NASH and NASH-related
References (35)
- et al.
Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008
Clin Gastroenterol Hepatol
(2011) - et al.
Thyroid hormone regulation of hepatic lipid and carbohydrate metabolism
Trends Endocrinol Metab
(2014) - et al.
Non-alcoholic fatty liver disease across the spectrum of hypothyroidism
J Hepatol
(2012) - et al.
Free triiodothyronine levels are positively associated with non-alcoholic fatty liver disease in euthyroid middle-aged subjects
Endocr Res
(2015) - et al.
Sarcopenia is an independent risk factor for non-alcoholic steatohepatitis and significant fibrosis
J Hepatol
(2017) - et al.
The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology
Gastroenterology
(2012) - et al.
Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions
Am J Gastroenterol
(1999) - et al.
Oxidative stress parameters in serum and low density lipoproteins of Hashimoto's thyroiditis patients with subclinical and overt hypothyroidism
Int Immunopharmacol
(2012) - et al.
Lipid lowering in healthy volunteers treated with multiple doses of MGL-3196, a liver-targeted thyroid hormone receptor-beta agonist
Atherosclerosis
(2013) - et al.
Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States
Hepatology
(2013)
Clinical review: A review of the clinical consequences of variation in thyroid function within the reference range
J Clin Endocrinol Metab
Low-normal thyroid function and the pathogenesis of common cardio-metabolic disorders
Eur J Clin Invest
Setpoints and susceptibility: do small differences in thyroid function really matter?
Clin Endocrinol (Oxf)
Thyroid hormone-mediated autophagy and mitochondrial turnover in NAFLD
Cell Biosci
Non-alcoholic fatty liver disease and thyroid dysfunction: a systematic review
World J Gastroenterol
Thyroid function and the risk of nonalcoholic fatty liver disease: The Rotterdam Study
J Clin Endocrinol Metab
Is hypothyroidism a risk factor for non-alcoholic steatohepatitis?
J Clin Gastroenterol
Cited by (124)
Targeting nuclear receptors for NASH/MASH: From bench to bedside
2024, Liver ResearchThe Interrelation Between Hypothyroidism and Non-alcoholic Fatty Liver Disease, a Cross-sectional Study
2023, Journal of Clinical and Experimental HepatologyThe association between thyroid hormones and MAFLD is mediated by obesity and metabolic disorders and varies among MAFLD subtypes
2023, Digestive and Liver Disease
Conflicts of interest The authors disclose no conflicts.
Funding This work was supported by the National Research Foundation of Korea grant funded by the Korea government (MEST) (2016R1D1A1B04934590), and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health & Welfare, Republic of Korea (H I17C0912).
- a
Authors share co-first authorship.