The relationship between liver histology and thyroid function tests in patients with nonalcoholic fatty liver disease (NAFLD)

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Background Data on the role of hypothyroidism in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis are conflicting, although selective Thyroid Hormone Receptor (THR)-β agonists have been identified as potential therapy in patients with non-alcoholic steatohepatitis (NASH). Therefore, we investigated the association between hypothyroidism and NAFLD histological features potentially associated with progressive liver disease. Methods Between 2014 and 2016, consecutive patients with histologically proven NAFLD and frozen serum available for thyroid function tests assessment were included. NAFLD was staged according to the NAFLD Activity Score (NAS), and fibrosis according to Kleiner. NASH was defined as NAS 4, significant fibrosis as F2-F4 and significant steatosis as S2-S3. Thyroid function tests (TFT; TSH, FT3, FT4, rT3), TPO-Ab and Tg-Ab were also assessed. Results Fifty-two patients were analyzed: Median age 54 years, 58% females, LSM 7.8 kPa, 27% diabetics, 14% hypothyroid. At histology, NASH was present in 21 (40%), F2-F4 in 28 (54%) and S2-S3 in 30 (58%) patients. Rates of hypothyroidism were similar independently of the presence of NASH (p = 0.11), significant fibrosis (p = 0.21) or steatosis (p = 0.75). However, hypothyroid patients displayed a higher NAS (p = 0.02) and NASH (p = 0.06) prevalence. At multivariate analysis, TFT were not independently associated with histology. Conclusion Hypothyroidism was highly prevalent in NAFLD patients, and was associated with increased NAFLD activity, but not with fibrosis and steatosis severity. Thus, thyroid dysfunction might play a direct and/or indirect in the pathogenesis of NAFLD and NASH.

Original languageEnglish
Article numbere0249614
JournalPLoS ONE
Issue number4
Publication statusPublished - 2021


  • aminotransferase
  • antilipemic agent
  • C reactive protein
  • ferritin
  • gamma glutamyltransferase
  • adult
  • aged
  • Article
  • body mass
  • clinical feature
  • cohort analysis
  • diabetes mellitus
  • disease activity
  • disease association
  • disease exacerbation
  • disease severity
  • euthyroidism
  • fatty liver
  • female
  • human
  • human tissue
  • hypercholesterolemia
  • hypertension
  • hypertriglyceridemia
  • hypothyroidism
  • liver biopsy
  • liver fibrosis
  • liver histology
  • liver stiffness
  • major clinical study
  • male
  • nonalcoholic fatty liver
  • Nonalcoholic Fatty Liver Disease Activity Score
  • obesity
  • prevalence
  • protein blood level
  • retrospective study
  • thyroid function test


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