Subclinical hypothyroidiSm (SCH) is characterized by an increased level of plasma TSH and normal levels of free thyroxin (FT4) and free triiodothyronine (FT3). With increasing evidence from clinical studies, the association between SCH and other diseases, such as hypercholesterolemia [1] and coronary heart disease [2], is receiving increasing attention. Some studies have also found associations between SCH and insulin resistance [3][4][5] or fasting hyperinsulinemia [6]. Amati [7] reported that SCH patients had significantly lower improvements in insulin sensitivity relative to euthyroid group under similar regular exercise and body weight loss. And some studies [8,9] observed an improvement of insulin sensitivity when Endocrine Journal 2013, 60 (8), [941][942][943][944][945][946][947][948][949][950] Decreased fasting blood glucose is associated with impaired hepatic glucose production in thyroid-stimulating hormone receptor knockout mice The hepatic cAMP/PKA/CREB pathway also plays an important role in maintaining fasting glucose homeostasis. These findings implied a possible role for TSH in hepatic glucose metabolism. In this study, we used TSH receptor knockout mice (Tshr-ko mice) to clarify the effect of Tshr deletion on hepatic glucose metabolism, and investigated whether the effects of TSH directly regulate hepatic gluconeogenesis in HepG2 cells. Tshr-ko mice exhibited decreased fasting blood glucose levels, increased insulin sensitivity but normal level of fasting plasma insulin. Tshr deletion impaired hepatic glucose production by down-regulating the expression of glucose-6-phosphatase (G6P) and phosphoenolpyruvate pyruvate carboxylase (PEPCK) mRNA, two rate-limiting enzymes in hepatic gluconeogenesis, and enhancing the abundance of hepatic glucokinase (GK), the first enzyme regulating glycogen synthesis. Moreover, Tshr deletion inhibited the protein expression of hepatic phospho-CREB and increased the protein expression of hepatic phospho-AMP-activated protein kinase (p-AMPK), two up-stream regulators of PEPCK and G6P mRNA. In HepG2 cells, TSH increased the expression of G6P and PEPCK at mRNA level. These results indicated the simulative effects of TSH on hepatic glucose production in vivo and in vitro, suggesting a novel role for TSH in hepatic glucose metabolism.Key words: Thyroid-stimulating hormone receptors (TSHR), Gluconeogenesis, cAMP regulatory element binding protein (CREB), AMP-activated protein kinase (AMPK) the level of serum TSH was reduced within the normal range in SCH patients. Moreover, in the population of nondiabetic elderly men, it was reported that the TSHR-Asp727Glu polymorphism was associated with insulin resistance, suggesting that TSHR plays a role in glucose metabolism [10]. Taken together, these clinical studies strongly suggest a possible role for TSH in glucose metabolism. TSH is synthesized and secreted by the pituitary gland and directly regulates thyroid function via binding to TSH receptor located in the membrane of thyrocytes. Recently, multiple studies have found that...