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Association Between Subclinical Hypothyroidism and MASLD: A Systematic Review and Meta-Analysis.

Gedion Yilma Amdetsion1, Chun-Wei Pan2, Hiwot Tebeje3

  • 1Department of Medicine, John H Stroger Jr Hospital of Cook County, Chicago, Illinois, USA.

International Journal of Hepatology
|December 8, 2025
PubMed
Summary

Subclinical hypothyroidism (SCH) is linked to a 46% higher chance of having metabolic dysfunction-associated steatotic liver disease (MASLD). SCH also increases the risk of developing MASLD over time, suggesting a need for routine screening for both conditions.

Keywords:
liver steatosismeta-analysismetabolic dysfunction associated liver diseasesubclinical hypothyroidism

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Area of Science:

  • Endocrinology
  • Hepatology
  • Epidemiology

Background:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent liver condition.
  • Overt hypothyroidism is a known MASLD risk factor, but the role of subclinical hypothyroidism (SCH) is unclear.
  • SCH affects approximately 4.6% of US adults.

Purpose of the Study:

  • To determine if subclinical hypothyroidism (SCH) is independently associated with MASLD.
  • To provide evidence for targeted screening recommendations for MASLD and SCH.

Main Methods:

  • Systematic literature search of multiple databases (PubMed, Embase, Cochrane, etc.) up to June 2025.
  • Inclusion of 10 high-quality studies with 71,332 participants.
  • Random-effects meta-analyses for cross-sectional and longitudinal data.

Main Results:

  • Subclinical hypothyroidism (SCH) was associated with 46% higher odds of prevalent MASLD (OR = 1.46).
  • SCH increased the risk of incident MASLD by 59% in longitudinal analyses (HR = 1.59).
  • Prospective studies showed a stronger association (HR = 1.90) with no heterogeneity.

Conclusions:

  • Subclinical hypothyroidism (SCH) is significantly associated with both prevalent and incident metabolic dysfunction-associated steatotic liver disease (MASLD).
  • Clinicians should consider routine screening for MASLD in patients with SCH and vice versa.