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Decoding thyroid: liver cross talk in type 2 diabetes mellitus-an MASLD perspective.

Sowmiya Subramani¹, S Gayathri¹, Karpagavel Lakshmanan¹

¹Department of Biochemistry, Chettinad Hospital and Research Institute(CHRI), CARE, Kelambakkam, Chengalpattu District, Tamil Nadu 603103 India.

Diabetology International

|July 13, 2026

Summary

Thyroid hormone resistance, indicated by higher FT3/FT4 and TFQI_FT3, is linked to Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) in euthyroid adults. Insulin resistance may play a role in this association.

Keywords:

Mediational effect analysis Metabolic dysfunction associated steatotic liver disease Thyroid hormone sensitivity indices Triglyceride glucose index

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Area of Science:

Endocrinology
Metabolic Diseases
Hepatology

Background:

Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) is a growing global health concern linked to metabolic abnormalities.
Thyroid hormones are crucial for lipid metabolism and energy balance.
This study investigates thyroid hormone resistance, not just levels, in MASLD development.

Purpose of the Study:

To assess the relationship between thyroid hormone sensitivity indices and MASLD in euthyroid adults with Type 2 Diabetes Mellitus (T2DM).

Main Methods:

534 euthyroid T2DM participants were analyzed.
Thyroid hormone sensitivity was measured using indices like FT3/FT4 ratio, TT3RI, TT4RI, TSHI, TFQI_FT3, and TFQI_FT4.
Regression analyses evaluated associations between indices and MASLD.

Main Results:

MASLD prevalence increased with higher FT3/FT4 ratio, TT3RI, and TFQI_FT3.
Elevated FT3/FT4 and TFQI_FT3 were independent risk factors for MASLD after adjusting for confounders.
The association was stronger in participants aged ≤40 years and partially mediated by the TyG index.

Conclusions:

Higher FT3/FT4 and TFQI_FT3 levels are strongly associated with MASLD prevalence in euthyroid individuals.
The TyG index partially mediates the link between thyroid hormone sensitivity and MASLD, indicating a role for insulin resistance.