Association between overt, subclinical hypothyroidism and metabolic dysfunction-associated steatotic liver disease using magnetic resonance imaging

Abstract

BACKGROUND

In addition to an elevated risk of cirrhosis and hepatocellular carcinoma, along with metabolic dysfunction-associated steatotic liver disease (MASLD) represents the primary contributor to chronic liver disease, affecting 30% of the global population. Hypothyroidism is a common disorder that may influence MASLD development. Limited data have addressed the association between the whole spectrum of hypothyroidism (overt, subclinical) and MASLD.

AIM

To determine the association between the whole spectrum of hypothyroidism (overt, subclinical) and MASLD and its severity determinants.

METHODS

This observational investigation encompassed 144 adult participants from Egypt, consisting of 48 subjects diagnosed with obvious hypothyroidism, 48 with subclinical hypothyroidism and 48 healthy control subjects, subsequent to the removal of those with a history of alcohol intake, diabetes mellitus, prediabetes, or any etiologies of chronic liver disease, such as chronic viral hepatitis B and C. All participants underwent evaluation for MASLD employing ultrasound imaging, with diagnosis thereafter corroborated through magnetic resonance imaging, and hepatic fat percentage (HF%) was determined to gauge MASLD severity at Kasralainy Hospitals, Cairo University, Egypt.

RESULTS

The 34 of the 48 overt hypothyroid, 27 of the 48 subclinical hypothyroid and 3 of the control group were diagnosed to have MASLD. Mild steatosis was 38.2% and 63% whereas moderate steatosis was 61.8% and 37% among the overt and subclinical groups respectively. The statistically significant predictor for the risk of MASLD development was the thyroid-stimulating hormone (TSH) level (22.9 ± 26.4, P value < 0.001). TSH correlated positively with the degree of steatosis independently of other factors according to HF% (r = 0.69, P value < 0.001). Multivariate analysis proved TSH as an autonomous determinant for MASLD development and severity. The receiver operating characteristic curve, with a sensitivity of 83% and a specificity of 89%, demonstrated TSH level of > 6.1 mIU/L or higher is associated with an increased risk of developing MASLD.

CONCLUSION

Overt and subclinical hypothyroidism are directly related to MASLD development. TSH exhibits an increased association with HF% and is an independent risk variable associated with the onset and severeness of MASLD.

Keywords: Metabolic dysfunction-associated steatotic liver disease; Hypothyroidism; Overt; Subclinical; Predictors; Fibrosis; Severity; Ultrasonography; Magnetic resonance imaging

Core Tip: Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the foremost etiology of cirrhosis and hepatocellular carcinoma. Our study assessed the overlooked association between this global liver disease and the spectrum of hypothyroidism. The three study groups (overt, subclinical hypothyroid, control) were assessed for MASLD by ultrasonography. The diagnosis was confirmed by magnetic resonance imaging, hepatic fat percentage was calculated. Ultrasound results were compared with magnetic resonance imaging findings to determine degree of agreement between both diagnostic methods. Multivariate analysis identified the independent risk variables associated with the onset and severeness of MASLD. The receiver operating characteristic curve concluded that there is a certain thyroid-stimulating hormone level above which the risk of MASLD development increases.