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03.06.2019 | Original Article | Ausgabe 8/2019

Digestive Diseases and Sciences 8/2019

Low Free Triiodothyronine Is Associated with Advanced Fibrosis in Patients at High Risk for Nonalcoholic Steatohepatitis

Zeitschrift:
Digestive Diseases and Sciences > Ausgabe 8/2019
Autoren:
Paul Manka, Lars Bechmann, Jan Best, Svenja Sydor, Lee C. Claridge, Jason D. Coombes, Ali Canbay, Lars Moeller, Guido Gerken, Heiner Wedemeyer, Wing-Kin Syn
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Abstract

Background

Thyroid hormone is critical for tissue–organ development, growth, differentiation, and metabolism. In murine models of advanced nonalcoholic steatohepatitis (NASH), the administration of T3 reduced liver triglyceride, repressed liver inflammation, and attenuated injury. In recent studies of patients with NASH, hypothyroidism was noted to be associated with more advanced NASH. These findings suggest that thyroid hormone function might be a modulator of nonalcoholic fatty liver disease (NAFLD) outcomes.

Aims

Herein, we evaluated the correlation between plasma TSH/free T3 (fT3)/free T4 (fT4) levels and (non-invasive) surrogate markers of NAFLD fibrosis.

Methods

We performed a retrospective analysis of 144 patients who were seen in our NASH outpatient clinic between 2015 and 2017. Each patient underwent a standard anthropometric assessment, laboratory and clinical evaluations, and liver stiffness measurements by transient elastography (Fibroscan). Univariate analysis and multivariate linear and logistic regression analysis were used to identify factors independently associated with NASH and advanced fibrosis.

Results

Low fT3 values but not TSH and fT4 were associated with higher liver stiffness and higher NAFLD fibrosis score, respectively. fT3 and TSH values correlated significantly with indices of liver disease including INR, albumin, ALT, AST, bilirubin, and platelets. In multivariate analyses, a low fT3 was independently associated with high NFS scores (OR 0.169, CI 0.05–0.54, p = 0.003) and was also associated with high liver stiffness readings (OR 0.326, CI 0.135–0.785, p = 0.001).

Conclusion

A low-normal thyroid hormone function is predictive of NASH and advanced fibrosis and may have a pathogenic role in modulating NAFLD outcomes.

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