TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

[helvella]

OK - I know that most members will wonder why on earth the researchers only measured TSH and not Free T4 and Free T3.

However, given current NICE guidelines encourage leaving patients until their TSH reaches 10, this paper's observation that non-alcoholic fatty liver disease (NFLD) and liver fibrosis rates rise with TSH above 2.5 should be seen as undermining that NICE recommendation.

I doubt many members will be surprised.

J Clin Med. 2021 Jun 29;10(13):2907.

doi: 10.3390/jcm10132907.

TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

Alba Martínez-Escudé 1 2 , Guillem Pera 1 3 , Anna Costa-Garrido 1 4 , Lluís Rodríguez 1 5 , Ingrid Arteaga 1 6 , Carmen Expósito-Martínez 1 7 , Pere Torán-Monserrat 1 3 , Llorenç Caballería 1 3

Affiliations

• PMID: 34209831

• DOI: 10.3390/jcm10132907

Abstract

Thyroid hormones may be a risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis. The aim of this study is to investigate the relationship between thyroid stimulating hormone (TSH) levels, NAFLD, and liver fibrosis in the general population. A descriptive cross-sectional study was performed in subjects aged 18-75 years randomly selected from primary care centers between 2012 and 2016. Each subject underwent clinical evaluation, physical examination, blood tests and transient elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with NAFLD and fibrosis. We included 2452 subjects (54 ± 12 years; 61% female). Subjects with TSH ≥ 2.5 μIU/mL were significantly associated with obesity, atherogenic dyslipidemia, metabolic syndrome (MetS), hypertransaminasemia and altered cholesterol and triglycerides. The prevalence of NAFLD and liver fibrosis was significantly higher in subjects with TSH ≥ 2.5 (μIU/mL). We found a 1.5 times increased risk of NAFLD, 1.8 and 2.3 times increased risk of liver fibrosis for cut-off points of ≥8.0 kPa and ≥9.2 kPa, respectively, in subjects with TSH ≥ 2.5 μIU/mL compared with TSH < 2.5 μIU/mL (control group), independent of the presence of MetS. These findings remained significant when stratifying TSH, with values ≥ 10 μIU/mL.

Keywords: liver fibrosis; metabolic syndrome; non-alcoholic fatty liver disease; obesity; thyroid function; thyroid stimulating hormone; transient elastography.

pubmed.ncbi.nlm.nih.gov/342...

Full paper freely available here:

mdpi.com/2077-0383/10/13/2907

[linda96]

Thank you Helvella.

Dr Andrew Lansdown said in his zoom talk about thyroid issues this last week, the sooner people are treated the better the long term outcome.

They can't have it both ways to suit ideological inclinations.

[helvella Administrator in reply to linda96]

I find it difficult to appreciate any reason, at least reasons which benefit the patient, to defer treatment - with one exception. Which is simply that we need to be sure it isn't a temporary/transient issue.

[NWA6 in reply to helvella]

Yes, such as long Covid, with the few that I know some of them are recovering from low T3 syndrome. Others don’t seem to be so lucky but no antibodies to indicate Hashi

[helvella Administrator in reply to NWA6]

How best to treat disorders like long Covid, and anything else that depresses T3 levels, doesn't appear to have a clear, definitive answer. So not at all sure sufferers should or shouldn't be given thyroid hormone - and whether T4, T3, or a combination, and how dosed. It is all open to question.

[NWA6 in reply to helvella]

Yes, it’s all very unclear but from what I know from friends with low T3 and Vits and minerals, their GP’s are not very supportive esp when the three I know personally are ‘in range’ and so just like us they say ‘you’re fine, it’s just Covid recovery’. I have tried my best to help them ignore GP’s ‘support’ and check and supplement Vits and minerals. So far only 1 has been interested in my ‘advice’ and they are monitoring their levels. So far very little change in thyroid hormones with FT4 and FT3 still at around 5 - 10% of range.

In this case I’m not sure they’ll recover natural optimal thyroid function, (about 1yr on from very serious Covid) but with a lack of thyroid antibodies it also doesn’t look like their GP’s are seeing the connection between their remaining lethargy and breathlessness and low results.

[greygoose]

Thyroid hormones may be a risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis.

Don't they know that TSH is not a thyroid hormone?

[KittyAO]

Thank you so much for this. I have been diagnosed with NAFLD and although overweight, and reducing, it is interesting to note. I will try and aim to keep my TSH reduced, however as we all know that isn't the best measure.

[holyshedballs]

Excellent find!!More grist to the mill about the guidance being illogical.