Low Thyroid Function and Liver Disease

Low thyroid function is associated with an increased risk of advanced fibrosis in patients with metabolic dysfunction-associated fatty liver disease, suggests a recent study published in the BMC Gastroenterology.

Study Overview

Observational studies showed that low thyroid function may perturb liver function. We aimed to evaluate the association of low thyroid function with both metabolic dysfunction-associated fatty liver disease (MAFLD) and advanced hepatic fibrosis.

Participants who underwent abdominal ultrasonography and thyroid function tests in a Chinese hospital from 2015 to 2021 were enrolled. Fibrosis-4 index (FIB-4) > 2.67 and/or non-alcoholic fatty liver disease fibrosis score (NFS) > 0.676 were used to define advanced fibrosis. Descriptive analyses were performed to characterize the epidemiology of MAFLD according to levels of thyroid-stimulating hormone (TSH). The logistic regression model was applied to estimate the association of low thyroid function with MAFLD and advanced fibrosis.

Results

• A total of 19,946 participants were included, among which 14,789 had strict-normal thyroid function, 4,328 had low-normal thyroid function, and 829 had subclinical hypothyroidism.
• TSH levels were significantly higher in MAFLD patients with a FIB-4 > 2.67 and/or NFS > 0.676 than their counterparts.
• The logistic regression model adjusted for age and sex showed that low-normal thyroid function increased the risk of MAFLD.
• Multivariable regression model adjusted for age, sex, body mass index, type 2 diabetes, and hypertension showed low-normal thyroid function increased the risk of advanced fibrosis in patients with MAFLD.
• Elevated TSH concentrations are associated with advanced hepatic fibrosis, even in the euthyroid state.

Take-Home Message

This study assessed the association of hypoglycemia with concomitant use of sulfonylureas and beta-blockers versus sulfonylureas alone in patients with type 2 diabetes. Overall, the risk of hypoglycemia was higher in patients on both medications than in those on sulfonylureas alone, even when adjusted for relative comorbidities such as heart failure and liver cirrhosis.

Patients may be at a higher risk for hypoglycemia with the use of beta-blockers in combination with sulfonylureas.

For Further Reference

Liu, Z. et al. Low thyroid function is associated with an increased risk of advanced fibrosis in patients with metabolic dysfunction-associated fatty liver disease. BMC Gastroenterol 23, 3 (2023). https://doi.org/10.1186/s12876-022-02612-3