ASSOCIATION BETWEEN HYPOTHYROIDISM AND NAFLD
Abstract
NAFLD is a chronic liver disease with a histological spectrum ranging from steatosis alone to non-alcoholic steatohepatitis (NASH), the latter having an increased risk for progression to cirrhosis. The prevalence of NAFLD in adults has been reported to be as high as 33% making it the most common cause of chronic liver disease. It is possible that hypothyroidism can be contributing to the dyslipidemia in NAFLD, which is a common abnormality in these patients. Early identification of at-risk patients is important since treatment of the hypothyroidism may reduce the risk of NAFLD and potential complications.
MATERIALS AND METHODS: The present prospective, observational study was conducted on 50 subjects presenting with clinical features/biochemical evidences suggestive of thyroid dysfunction. Exclusion criteria included were <18 year age, with any hepatitis virus infections, hemochromatosis, elevated alcohol consumption, intake of iodine or antithyroid agents.
RESULTS: A total of 50 subjects fulfilling inclusive criteria were taken up for study. These included four (8%) subjectives with features suggestive of subclinical hypothyroidism and 46 (92%) with those of clinical hypothyroidism. A total of 12 (24%) subjects with spectrum of steatosis alone to non-alcoholic steatohepatitis (NASH) were diagnosed ultrasonographically. All these subjects had features of clinical hypothyroidism.
Hypothyroidism enhances the degree of insulin resistance in NAFLD patients and may increase the already elevated lipolysis and free fatty acid delivery to the liver and thereby accelerate liver injury in NAFLD. Hypothyroidism primarily causes elevation in cholesterol and low density lipoproteins and also affects the synthesis, mobilization and degradation of all aspects of lipid metabolism. Early identification of at-risk patients is important since treatment of the hypothyroidism may reduce the risk of NAFLD and potential complications.
Keywords: Hypothyroidism, Non alcoholic fatty liver disease (NAFLD), non alcoholic steatohepatitis (NASH)
