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

Abstract

Hypothyroidism is associated with the risk of development of the metabolic syndrome (MS) and hypercholesterolemia. Direct evidence that hypothyroidism might be associated with advanced chronic liver disease via nonalcoholic steatohepatitis (NASH) is limited. We studied the relationship between thyroid hormones, thyroid stimulating hormone (TSH), cholesterol, and NASH. In consecutive euthyroid patients with biopsy-proven nonalcoholic fatty liver disease, TSH and thyroid hormone (FT3 and FT4) concentrations were compared in 25 patients with steatosis and 44 non-cirrhotic NASH patients featuring concurrent ballooning, lobular inflammation and steatosis. The MS was diagnosed according to ATP III criteria. A meta-analysis of previously published studies was performed to evaluate whether NASH, compared to simple steatosis, is associated with lower cholesterol levels. At univariate analysis, compared to those with steatosis, patients with NASH have a wider waist, elevated levels of BMI, ALT, AST, fasting insulin, HOMA-IR, ferritin, TSH and a lower serum cholesterol. At stepwise multivariable logistic regression analysis, the independent predictors of NASH are high HOMA and TSH and lower total cholesterol (Model 1); MS and high TSH (Model 2). At meta-analysis, serum total cholesterol levels are significantly lower in predominantly non-cirrhotic NASH than in simple steatosis. This study provides cross-sectional and meta-analytic evidence that, in euthyroid patients, high-though-normal TSH values are independently associated with NASH. Further work is needed to ascertain the role, if any, of lower cholesterol serum levels in assisting in the diagnosis of NASH.

Association and impact of non-alcoholic fatty liver disease on thyroid function

“…Beside the inverse association with FT4, Chung et al and Xu et al identified a positive association between NAFLD and TSH. This association was observed in other studies (32,35).…”

“…Previous studies have investigated the association between NAFLD and thyroid function in adult or elderly patients (29,30,32,33 ). The study by Targher et al involving a large cohort of unselected adult outpatients was the first to report a strong association between thyroid function tests and serum liver enzyme activity concentrations (33).…”

Mechanisms in endocrinology: Non-alcoholic fatty liver disease in common endocrine disorders

“…The prevalence of hypothyroidism among a cohort of 246 patients with biopsy-proven NAFLD was 21 vs 9.5% in 430 age-, gender-, race-and BMI-matched controls (90). In addition, the prevalence of hypothyroidism in patients with NASH is higher than those with more benign disease (90,91). There are currently no published studies that have examined NAFLD in the context of hyperthyroidism.…”

Hyperthyroidism Improves the Pathological Condition of Nonalcoholic Steatohepatitis: A Case of Nonalcoholic Steatohepatitis with Graves' Disease

“…Hypothyroidism is associated with a risk of developing metabolic syndrome, and several groups have shown the relationship between hypothyroidism and NAFLD and hypothyroidism and NASH (6)(7)(8)(9)(10). However, the relationships between hypothyroidism and NAFLD and hypothyroidism and NASH remain controversial.…”