Thyroid hormone sensitivity tied to advanced liver fibrosis in NAFLD

In euthyroid patients with nonalcoholic fatty liver disease (NAFLD), higher values of thyroid hormone sensitivity markers, such as the thyroid-stimulating hormone (TSH) index (TSHI) and thyroid feedback quantile-based index (TFQI), appear to aggravate the risk of advanced fibrosis, a recent study has found.

The study included 129 patients in whom euthyroid NAFLD was proven through biopsy analysis. Nearly a third of the sample (31.0 percent; n=40) had advanced fibrosis. In these patients, levels of free triiodothyronine (FT3; p=0.002), TSH (p=0.001), TSHI (p=0.001), TFQI (p=0.023), and TSH T4 resistance index (TT4RI; p<0.001) were all significantly higher than in those without advanced fibrosis.

Logistic regression analysis, adjusted for baseline demographics, comorbidities, and other confounders, showed that FT3 was indeed significantly correlated with an increased likelihood of advanced fibrosis (odds ratio [OR], 2.128, 95 percent confidence interval [CI], 1.122–4.037; p=0.021). The same was true for TSH (OR, 1.831, 95 percent CI, 1.2–2.795; p=0.008).

In addition, each 1-standard deviation increase in TSHI (OR, 2.046, 95 percent CI, 1.242–3.369; p=0.005) and TT4RI (OR, 2.026, 95 percent CI, 1.296–3.167; p=0.002) led to a significant doubling of advanced fibrosis risk. The same change in TFQI upped the likelihood of advanced fibrosis by more than 60 percent (OR, 1.628, 95 percent CI, 1.047–2.53; p=0.03).

“Older patients with NAFLD with lower central sensitivity to thyroid hormones and dyslipidaemia should be treated to prevent the progression of liver fibrosis. However, extensive studies are necessary to confirm our results and reveal their potential mechanisms,” the researchers said.