Hypothyroidism in Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease with increasing global prevalence. Thyroid dysfunction, particularly hypothyroidism, has been implicated in its pathogenesis and progression.

To evaluate the prevalence and pattern of hypothyroidism in NAFLD patients and assess its association with hepatic steatosis and fibrosis severity using imaging and noninvasive fibrosis scoring systems.

This cross-sectional observational study was conducted on 158 adult NAFLD patients at a tertiary care hospital in northern India over 1 year. Patients with significant alcohol intake or other chronic liver diseases were excluded. Hepatic steatosis and fibrosis were assessed by ultrasonography and transient elastography, respectively. Fibrosis severity was categorized using FibroScan and the FIB-4 index. Thyroid function was evaluated by serum TSH, FT3, and FT4. Statistical analysis included intergroup comparisons and correlation assessments using SPSS v26, with p < 0.05 considered significant.

Among 158 NAFLD patients, 41.14% were hypothyroid. The prevalence of hypothyroidism increased with disease severity: 71.43% in fibrotic NASH and 44.44% in cirrhosis (FibroScan-based). A dose-response trend was observed between steatosis grade and hypothyroidism, reaching 80% in grade 3 steatosis. FT4 showed a significant positive correlation with liver stiffness (r = 0.432, p < 0.001). Additional associations included positive correlations of liver stiffness with urea and INR, and negative correlations with serum protein, fasting glucose, and LDL. Overall, hypothyroidism emerged as a significant cofactor in NAFLD pathogenesis and fibrosis progression.

This study demonstrates a strong association between hypothyroidism and both hepatic steatosis and fibrosis in NAFLD. Routine thyroid function screening is recommended in NAFLD patients, particularly those with metabolic syndrome or suspected fibrosis. Early detection and treatment of hypothyroidism may provide therapeutic benefits in slowing or reversing NAFLD progression.