Relationship between hypothyroidism and non-alcoholic fatty liver disease in the Spanish population

Escudé, Alba Martínez; Pera, Guillem; Arteaga, Ingrid; Expósito, Carmen Barranco; Rodríguez, Lluis; Caballería, Llorenç

doi:10.1016/j.medcle.2019.03.025

Cited by 14 publications

(10 citation statements)

References 25 publications

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“…Although there is still some controversy in the relationship between TH and NAFLD, it is plausible to think that both entities are linked, either by a direct effect of TH or by an effect mediated by the components of MetS. A low thyroid function is associated with increases in cholesterol and TG levels, and with greater weight gain, which in turn are risk factors for the development of NAFLD [41]. We have demonstrated these same findings in our study.…”

Section: Discussionsupporting

confidence: 84%

“…THs have been correlated with moderate elevations in transaminase levels. In an observational study in our setting, where 10,116 subjects were included, it was found that the alteration in AST levels affected subjects with TSH ≥ 10 µIU/mL more frequently and significantly; it was also more prevalent in subjects with low T4 levels [41]. Along the same lines, Chung et al demonstrated the association between alteration of ALT > 33/25 (men/women) and thyroid function, affecting 20.1% of subjects with subclinical hypothyroidism and 25.9% in clinical hypothyroidism [10].…”

Section: Discussionmentioning

confidence: 93%

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TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

Escudé

Pera

Costa-Garrido

et al. 2021

JCM

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Thyroid hormones may be a risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis. The aim of this study is to investigate the relationship between thyroid stimulating hormone (TSH) levels, NAFLD, and liver fibrosis in the general population. A descriptive cross-sectional study was performed in subjects aged 18–75 years randomly selected from primary care centers between 2012 and 2016. Each subject underwent clinical evaluation, physical examination, blood tests and transient elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with NAFLD and fibrosis. We included 2452 subjects (54 ± 12 years; 61% female). Subjects with TSH ≥ 2.5 μIU/mL were significantly associated with obesity, atherogenic dyslipidemia, metabolic syndrome (MetS), hypertransaminasemia and altered cholesterol and triglycerides. The prevalence of NAFLD and liver fibrosis was significantly higher in subjects with TSH ≥ 2.5 (μIU/mL). We found a 1.5 times increased risk of NAFLD, 1.8 and 2.3 times increased risk of liver fibrosis for cut-off points of ≥ 8.0 kPa and ≥ 9.2 kPa, respectively, in subjects with TSH ≥ 2.5 μIU/mL compared with TSH < 2.5 μIU/mL (control group), independent of the presence of MetS. These findings remained significant when stratifying TSH, with values ≥ 10 μIU/mL.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 93%

TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

Escudé

Pera

Costa-Garrido

et al. 2021

JCM

Self Cite

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“…On the other hand, there are some studies showing the opposite ( Table 1 ). Escude et al 22 in a recent retrospective study involving 10116 subjects showed no significant connections concerning hypothyroidism and NAFLD with respect to controls. In a longitudinal cohort study in South Korea including 18500 subjects with hypothyroidism, both clinical and subclinical, did not find any significant correlation with increased risk of NAFLD.…”

Section: Epidemiological Backgroundmentioning

confidence: 89%

Hypothyroidism and Nonalcoholic Fatty Liver Disease: Pathophysiological Associations and Therapeutic Implications

Kizivat

Marić

Mudri

et al. 2020

Journal of Clinical and Translational Hepatology

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Nonalcoholic fatty liver disease (NAFLD) is a complex clinical entity which can be secondary to many other diseases including hypothyroidism, characterized by lowering of thyroid hormones and increased thyroid stimulating hormone (TSH). A lot of emerging data published recently advocates the hypothesis that hypothyroid induced NAFLD could be a separate clinical entity, even suggesting possible treatment options for NAFLD involving substitution therapy for hypothyroidism along with lifestyle modifications. In addition, a whole new field of research is focused on thyromimetics in NAFLD/NASH treatment, currently in phase 3 clinical trials. In this critical review we summarized epidemiological and pathophysiological evidence linking these two clinical entities and described specific treatment options with the accent on promising new agents in NAFLD treatment, specifically thyroid hormone receptor (THR) agonist and its metabolites.

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“…Whether weight changes lead to TD or TD leads to weight changes is controversial. Hypothyroidism is associated with higher body mass index (BMI) and a higher prevalence of obesity [ 29 , 30 ]. TH plays a significant role in food intake, lipid and glucose metabolism, and fat oxidation.…”

Section: Metabolic Dysfunctionsmentioning

confidence: 99%

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Kalra

Aggarwal²,

Khandelwal

2021

International Journal of Endocrinology

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Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.

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Relationship between hypothyroidism and non-alcoholic fatty liver disease in the Spanish population

Cited by 14 publications

References 25 publications

TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

Hypothyroidism and Nonalcoholic Fatty Liver Disease: Pathophysiological Associations and Therapeutic Implications

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

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