Prevalence of hypothyroidism and effect of thyroid hormone replacement therapy in patients with non-alcoholic fatty liver disease: A population-based study

Abstract

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is currently considered as the most common cause of chronic liver disease worldwide. Risk factors for NAFLD have been well-described, including obesity, type 2 diabetes mellites (T2DM), dyslipidemia (DLP) and metabolic syndrome. Hypothyroidism has been identified as an independent risk factor for the development of NAFLD, although the literature is inconsistent AIM To evaluate the prevalence of hypothyroidism in patients with NAFLD, assess if it is an independent risk factor and explore the effect of thyroxine replacement therapy. METHODS Our cohort’s data was obtained using a validated, large, multicenter database (Explorys Inc, Cleveland, OH, United States) aggregated from pooled outpatient and inpatient records of 26 different healthcare systems, consisting of a total of 360 hospitals in the United States, and utilizing Systematized Nomenclature of Medicine-Clinical Terms for coding. We evaluated a cohort of patients with hypothyroidism and NAFLD. Multivariate analysis was performed to adjust for confounding risk factors including hypertension (HTN), T2DM, DLP, obesity and metabolic syndrome. SPSS version 25, IBM Corp was used for statistical analysis, and for all analyses, a 2-sided P value of < 0.05 was considered statistically significant. Exclusion criteria were limited to age < 18 years. RESULTS Among the 37648180 included individuals in this database who are above the age of 18 years, there were a total of 2320 patients with NAFLD (6.16 per 100000) in the last five years (2015-2020), amongst which 520 patients (22.4%) had hypothyroidism. Baseline characteristics of patients in this database are described in Table 1 . Patients with NAFLD were also more likely to have obesity, T2DM, DLP, HTN, and metabolic syndrome (Table 2 ). While males and females were equally affected, patients in the age group 18-65 years as well as Caucasians seem to be at a higher risk. There was an increased risk of NAFLD among patients with hypothyroidism (OR = 1.587). Furthermore, thyroid hormone replacement was not associated with a decreased risk for developing NAFLD (OR = 1.106, C = 0.952-1.285, P = 0.303). CONCLUSION Hypothyroidism seems to be an independent risk factor for the development of NAFLD. Thyroid hormone replacement did not provide a statistically significant risk reduction. Further studies are needed to evaluate the effect of thyroid hormone replacement and assess if being euthyroid while on thyroid replacement therapy affects development and/or progression of NAFLD.

Non‐alcoholic steatohepatitis is independently associated with a history of gestational diabetes mellitus

“…Moreover, our study is limited by the fact that the definition of NASH and GDM could have been heterogeneous across different United States centers. Despite its limitations, Explorys platform has been validated as a database in several different fields including gastroenterology and endocrinology 11,12,24–26 . It is also an excellent research tool that provides clinicians with fruitful resources to investigate disease epidemiology and burden on a large population scale.…”

“…Despite its limitations, Explorys platform has been validated as a database in several different fields including gastroenterology and endocrinology. 11,12,[24][25][26] It is also an excellent research tool that provides clinicians with fruitful resources to investigate disease epidemiology and burden on a large population scale.…”

Metabolic Disease and Risk of Thyroid Disease: Evidence from the National Nurse Health Cohort in China

“…In the Third National Health and Nutrition Examination Survey (NHANES III), Fan and his colleagues found that BMI and ALT partially mediated the association between TSH and NAFLD (Fan et al, 2022). There is evidence that individuals with high levels of TSH, especially those diagnosed with hypothyroidism, are more likely to develop NAFLD (Almomani et al, 2022; Fan et al, 2022). In our study, BMI was an independent risk factor for thyroiditis.…”

Cirrhotic patients on proton pump inhibitors are at a twofold risk of spontaneous bacterial peritonitis independently of gastrointestinal bleeding: a population-based retrospective study

“…Access to the database is granted to participating healthcare systems. The use of the Explorys platform has been validated in multiple fields, including gastroenterology and endocrinology [ 24 , 25 ].…”