FT3/FT4 ratio predicts non-alcoholic fatty liver disease independent of metabolic parameters in patients with euthyroidism and hypothyroidism

Abstract

OBJECTIVE:This study was performed to evaluate the effects of metabolic parameters and thyroid dysfunction on the development of non-alcoholic fatty liver disease (NAFLD).METHODS:The current study evaluated a total of 115 patients, 75 female and 40 male. Physical examination and anthropometric measurements were applied to all participants. Hypothyroidism was considered at a thyroid stimulating hormone level ≥ 4.1 mIU/L. Patients with euthyroidism and patients with hypothyroidism were compared. Abdominal ultrasonography was used to diagnose non-alcoholic fatty liver disease. The participants were further compared with regard to the presence of non-alcoholic fatty liver disease. Logistic regression modeling was performed to identify the relationship between non-alcoholic fatty liver disease and independent variables, such as metabolic parameters and insulin resistance.RESULTS:Non-alcoholic fatty liver disease was identified in 69 patients. The mean waist circumference, body mass index, fasting plasma insulin, HOMA-IR (p<0.001) and FT3/FT4 ratio (p=0.01) values were significantly higher in the patients with NAFLD compared to those without it. Multivariate regression analysis revealed that FT3/FT4 ratio, waist circumference and insulin resistance were independent risk factors for non-alcoholic fatty liver disease.CONCLUSION:Insulin resistance, enlarged waist circumference, elevated body mass index, higher FT3/FT4 ratio and hypertriglyceridemia are independent risk factors for NADLF, whereas hypothyroidism is not directly related to the condition.

FT3 to FT4 Ratio is Associated with Non-Alcoholic Steatohepatitis and Significant Fibrosis in Euthyroid Subjects&nbsp;with NAFLD

“…Liver biopsy is the gold standard for NAFLD diagnosis, the accuracy of using noninvasive markers and ultrasonography for the diagnosis of NALFD may in uenced by the misclassi cation 27 and hyposensitivity 28 . Eline et al 21 and Fatma et al 22 previously reported that higher fT3/fT4 ratio but not TSH is a risk factor for NAFLD independent of metabolic parameters, which is consistent with ours.…”

“…However, there is no consensus. In the previous ndings, based on different sample sizes and diagnosis methods of NAFLD, they showed that low-normal thyroid function (higher plasma TSH level [2.5 to 4.5 mIU/L] with a normal thyroid hormone level) 18 , low serum free thyroxine level(fT4) 19 , high serum free triiodothyronine level(fT3) 20,21 , and high fT3/fT4 ratio 22 were risk factors for NAFLD respectively.…”

Nonalcoholic Fatty Liver Disease Is Not Associated with Thyroid Hormone Levels and Hypothyroidism: A Systematic Review and Meta-Analysis

“…A total of 5 studies [14,15,16,20,27] involving 26,454 participants, 6 studies [14,15,16,20,23,27] involving 27,070 studies, and 9 studies [14,15,16,17,18,20,25,26,27] involving 32,347 participants were included in our meta-analyses for assessing the association between NAFLD and subclinical hypothyroidism, overt hypothyroidism, and overall hypothyroidism, respectively. NAFLD was not associated with subclinical hypothyroidism (pooled OR = 0.63, 95% CI: 0.18-2.20, p = 0.47, I 2 = 97%, p heterogeneity <0.01), overt hypothyroidism (pooled OR = 1.37, 95% CI: 0.78-2.41, p = 0.27, I 2 = 81%, p heterogeneity = 0.08), or overall hypothyroidism (pooled OR = 1.21, 95% CI: 0.91-1.61, p = 0.18, I 2 = 72%, p heterogeneity = 0.02) compared with non-NAFLD controls (Fig.…”

“…Eleven articles were excluded (4 articles had no comparison group, 3 articles did not report a subject of interest, and 4 articles did not report an outcome of interest). Fourteen observational studies (9 cross-sectional studies [14,15,16,17,18,19,20,21,22], 4 case-control studies [23,24,25,26], and 1 cohort study [27]) involving 7,191 NAFLD patients and 30,003 controls were included in the meta-analysis. Table 1 describes the detailed characteristics and quality assessment of the included studies.…”

“…A total of 6 studies [15,16,17,19,21,22] involving 6,294 participants, 7 studies [15,16,17,19,21,22,27] involving 24,838 studies, and 9 studies [15,16,17,19,20,21,22,24,27] involving 26,147 participants were included in our meta-analyses for assessing the association between NAFLD and FT 3 , FT 4 , and TSH, respectively. Patients who had NAFLD did not show a significant difference concerning FT 3 (pooled MD = 0.04, 95% CI: -0.11 to 0.19, p = 0.61, I 2 = 96%, p heterogeneity <0.01), FT 4 (pooled MD = -0.27, 95% CI: -0.70 to 0.16, p = 0.22, I 2 = 98%, p heterogeneity <0.01), and TSH (pooled MD = 0.11, 95% CI: -0.03 to 0.24, p = 0.12, I 2 = 88%, p heterogeneity = 0.03) compared with non-NAFLD controls (Fig.…”