Is Hypothyroidism a Risk Factor for Non-Alcoholic Steatohepatitis?

  title={Is Hypothyroidism a Risk Factor for Non-Alcoholic Steatohepatitis?},
  author={Suthat Liangpunsakul and Naga P. Chalasani},
  journal={Journal of Clinical Gastroenterology},
Purpose Thyroid hormones play an important role in the regulation of lipid and carbohydrate metabolism, both of which are affected in patients with non-alcoholic steatohepatitis (NASH). Anecdotally, we have observed that a number of patients with NASH carried a diagnosis of hypothyroidism. However, it is unknown if thyroid dysfunction plays any role in the pathogenesis of NASH. To further investigate this observation, we conducted a case-control study to determine the association between… 

Thyroid-stimulating hormone is associated with nonalcoholic steatohepatitis in patients with chronic hepatitis B

Elevated serum TSH level was the independent predictive factor of incident NASH in patients with CHB and whether the thyroid function parameters should be integrated into future diagnostic scores predicting advanced diseases requires further study.

Prevalence of Hypothyroidism in Nonalcoholic Fatty Liver Disease

A higher prevalence of hypothyroidism was demonstrated in patients with NAFLD compared to controls, and among subjects with NALFD, female gender, increased BMI and history of abstinence from alcohol were associated with hypothyroism.

Is nonalcoholic steatohepatitis associated with a high-though-normal thyroid stimulating hormone level and lower cholesterol levels?

Evidence is provided that, in euthyroid patients, high-though-normal TSH values are independently associated with NASH, and the role, if any, of lower cholesterol serum levels in assisting in the diagnosis of NASH is ascertained.


Hypothyroidism enhances the degree of insulin resistance inNAFLD patients and may increase the already elevated lipolysis and free fatty acid delivery to the liver and thereby accelerate liver injury in NAFLD.

Non-alcoholic fatty liver disease across the spectrum of hypothyroidism.

Gluco-lipidic indices in treated hypothyroidism associated with nonalcoholic fatty liver disease.

A link could be identified between hypothyroidism and markers of glucose and lipid homeostasis, but not with severity of nonalcoholic fatty liver disease (NAFLD).

Unraveling the Role of Hypothyroidism in Non-alcoholic Fatty Liver Disease Pathogenesis: Correlations, Conflicts, and the Current Stand

It is recommended that comprehensive, long-term prospective studies be carried out to determine if HT or thyroid function parameters are causally associated with NAFLD.

Non-alcoholic fatty liver disease and thyroid dysfunction: a systematic review.

The results of the studies on the role of thyroid abnormalities in NAFLD/NASH are inconsistent, and further research is recommended to determine the relationship between hypothyroidism and NAFLd/Nash and the underlying mechanisms.

Prevalence of Hypothyroidism in Patients with Nonalcoholic Fatty Liver Disease

It was demonstrated that patients with hypothyroidism were more likely to have Nonalcoholic Fatty Liver Disease and NASH than controls and that female gender and increased BMI were associated with hyp Timothyroidism.



Update on nonalcoholic fatty liver disease.

Treatment consists of managing the comorbidities: obesity, diabetes, and hyperlipidemia, and ursodeoxycholic acid is the only drug that has shown benefit and is the most promising of the drugs currently being investigated.

Non-alcoholic fatty liver: another feature of the metabolic syndrome?

There is a strong association between nonalcoholic fatty liver and features of the metabolic syndrome, suggesting a simultaneous insulin resistance and decreased sensitivity to leptin.

The natural history of nonalcoholic steatohepatitis: A follow‐up study of forty‐two patients for up to 21 years

In individual patients, poorly controlled diabetes and rapid weight loss preceded the onset of steatohepatitis, and in the patients with extensive fibrosis the the liver disease evolved from one of active inflammation to one of inactive cirrhosis without fat or inflammation.

Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis

Older age, obesity, and presence of diabetes mellitus help identify those NASH patients who might have severe liver fibrosis, and this is the subgroup of patients who would be expected to derive the most benefit from having a liver biopsy and considering investigational therapies.

Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities.

Data indicate that peripheral insulin resistance, increased fatty acid beta oxidation, and hepatic oxidative stress are present in both fatty liver and NASH, but NASH alone is associated with mitochondrial structural defects.

Nonalcoholic steatohepatitis

Initial treatment protocols for NASH focus on various aspects of injury in an attempt to control insulin imbalances, improve lipid regulation, reduce free radicals, and ameliorate the inflammatory process.

Effect of thyroid function on LDL oxidation.

In hyperthyroid patients, the increased lipid peroxidation was strictly related to free thyroxine levels, whereas in hypothyroidism it was strongly influenced by serum lipids.