Prevalence of hypothyroidism in nonalcoholic fatty liver disease in patients attending a tertiary hospital in western India

Abstract

The aim of this study was to assess the prevalence of hypothyroidism in patients with nonalcoholic fatty liver disease (NAFLD). The patients visiting Gastroenterology outpatient clinic between September 2011 and September 2013 at our tertiary care center were investigated for NAFLD. Three hundred controls were selected on the basis of negative ultrasound examination. All patients above 18 years were included. All patients with alcohol intake greater than 20 g/day, HBsAg or anti-HCV positivity, and history of liver disease were excluded. Full thyroid profile was carried out in all patients and they were classified as follows: subclinical hypothyroidism (TSH >5.5 IU/mL but <10 IU/mL) and overt hypothyroidism (TSH >10 IU/mL). Eight hundred (500 NAFLD and 300 controls) patients were studied. The mean age of NAFLD patients was 44.3 years and of controls was 41.6 years, respectively. The female-to-male ratio of NAFLD patients was 1.8:1 and of controls was 1.94:1, respectively (p>0.05). Hypothyroidism was significantly more common in NAFLD patients compared to controls. Eighty-four patients were detected to have hypothyroidism in NAFLD group compared to only four patients in control group (p<0.001). Mean ALT (55 vs. 21 IU), AST (44 vs. 18 IU), and BMI (29.17 vs. 25.14 kg/m2) were significantly higher in NAFLD hypothyroid group compared to nonhypothyroid NAFLD. Multivariate regression analysis showed that NAFLD was statistically significantly associated with hypothyroidism [odds ratio (OR) 14.94, 95 % confidence interval (CI), 3.5 to 62.6]. Steatohepatitis was more common in hypothyroid as compared to nonhypothyroid group [OR 3.9, 1.2 to 11.1 (95 % CI)]. The prevalence of hypothyroidism in NAFLD was 16.8 %. Hypothyroidism was closely associated with NAFLD independently of known metabolic risk factors, confirming a significant clinical relationship between these two diseases.

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

“…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 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.…”

Non-alcoholic fatty liver disease and thyroid function in adult patients

“…We retrieved and evaluated 31 articles in more detail, of which 18 articles were excluded, leaving 13 studies that were eligible for inclusion ( Figure 1). [15][16][17][18][19][20][21][22][23][24][25][26][27] Main characteristics of included studies have been summarized in Table 1 Meta-analysis of the 13 studies found a high correlation between hypothyroidism (including both overt hypothyroidism and subclinical hypothyroidism) and NAFLD (OR=1.48, 95% CI 1.22-1.91, p<0.001)…”

Study on Association of Hypothyroidism in Patients with Nonalcoholic Fatty Liver Disease

“…There is no proven cause-effect relationship between the two conditions. In Indian cohort, patients with NAFLD had higher serum TSH level and lower free thyroxine level than control subjects (12,13). In Germany cohort, there was a confirm association between both subclinical and clinical hypothyroidism and hepatic steatosis (14).…”