Exploring the Relationship Between Hypothyroidism and Metabolic Dysfunction-Associated Steatotic Liver Disease

Abstract A comprehensive evaluation of metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence among hypothyroid patients and its correlation with hepatic stiffness, particularly using advanced diagnostic tools like transient elastography (TE) and serological parameters, has yet to be fully explored. A cross-sectional study was conducted involving patients with subclinical or overt hypothyroidism. MASLD was diagnosed by ultrasonography, and hepatic stiffness was assessed by TE. Patients were stratified by MASLD severity and hepatic stiffness, and statistical analyses, including logistic regression, were performed. We found a high prevalence (47%) of MASLD in hypothyroid patients. A positive correlation was found between TSH levels and both the severity of fatty liver and hepatic stiffness. Hepatic steatosis was found in 34.38% of people who were subclinical hypothyroid (SCH), and 60.29% of people who were overt hypothyroid. The prevalence of hepatic stiffness was 27.3% (9.38% in SCH and 44.12% in overt hypothyroid). Serum total thyroxine (T4) levels were inversely associated with MASLD severity, and logistic regression revealed a positive association between TSH and hepatic steatosis and fibrosis. In this cohort of individuals with hypothyroidism, MASLD and fibrosis markers were common, and higher TSH levels were associated with greater steatosis and fibrosis severity, including after adjustment for body mass index within the cohort. Controlled studies with matched euthyroid comparators are required to confirm whether hypothyroidism independently increases MASLD risk at the population level.