Liver fibrotic burden across the spectrum of hypothyroidism

Abstract

Background: Data regarding the prevalence of hepatic fibrotic burden across the spectrum of hypothyroidism are scarce. Hence, we aimed to evaluate the prevalence of liver fibrotic burden across the spectrum of hypothyroidism.

Methods: 30,091 individuals who attended a Health Management Centre between 2019 and 2021 were cross-sectionally analyzed. Participants were categorized as having strict-normal thyroid function, low-normal thyroid function, subclinical hypothyroidism, and overt hypothyroidism. Hepatic fibrosis was assessed by vibration-controlled transient elastography (VCTE). Significant and advanced fibrosis were defined as liver stiffness measurement in VCTE of 8.1-9.6 and 9.7-13.5 kPa, respectively.

Results: Among both men and women, low-normal thyroid function group, subclinical hypothyroidism group, and overt hypothyroidism group all have more liver fibrosis present, including mild fibrosis, significant fibrosis, advanced fibrosis, and cirrhosis, than the strict-normal thyroid function group. The low-normal thyroid function group have the similar liver fibrotic burden to the subclinical hypothyroidism group. The highest liver fibrotic burden was noted in the overt hypothyroidism group. Both significant and advanced liver fibrosis were significantly associated with low-normal thyroid function, subclinical hypothyroidism, and overt hypothyroidism in both men and women.

Conclusions: Liver fibrotic burden are highly prevalent in subjects with overt hypothyroidism. Moreover, fibrotic burden increased across the spectrum of hypothyroidism even within the low normal thyroid function. These results suggested that screening for liver fibrosis in patients with hypothyroidism is necessary.

Keywords: Advanced fibrosis; Hypothyroidism; Liver stiffness; Metabolic dysfunction-associated steatotic liver disease; Significant fibrosis.

Fig. 1

The flow diagram for the target population included in the study

Fig. 2

Metabolic dysfunction-associated steatotic liver disease (MASLD) and fibrotic burden across the spectrum of hypothyroidism in men and women. A Prevalence of ultrasonographic-defined MASLD across the spectrum of hypothyroidism in men and women; B Prevalence of controlled attenuation parameter-defined MASLD across the spectrum of hypothyroidism in men and women; C Prevalence of fibrotic stages across the spectrum of hypothyroidism in men; D Prevalence of fibrotic stages across the spectrum of hypothyroidism in women; E Prevalence of fibrotic burden in each hypothyroidism status in men. F Prevalence of fibrotic burden in each hypothyroidism status in women

Fig. 3

Fibrotic burden across the spectrum of hypothyroidism by metabolic dysfunction-associated steatotic liver disease (MASLD) status and the number of cardiometabolic disorders in men and women. The term “5 risk factors” indicates individuals with five cardiometabolic risk factors that used to define MASLD. A Prevalence of significant liver fibrosis in male patients with ultrasonographic-defined MASLD across the spectrum of hypothyroidism by the number of cardiometabolic disorders; B Prevalence of significant liver fibrosis in female patients with ultrasonographic-defined MASLD across the spectrum of hypothyroidism by the number of cardiometabolic disorders; C Prevalence of significant liver fibrosis in male patients with CAP-defined MASLD across the spectrum of hypothyroidism by the number of cardiometabolic disorders; D Prevalence of significant liver fibrosis in female patients with CAP-defined MASLD across the spectrum of hypothyroidism by the number of cardiometabolic disorders; E Prevalence of advanced liver fibrosis in male patients with ultrasonographic-defined MASLD across the spectrum of hypothyroidism by the number of cardiometabolic disorders; F Prevalence of advanced liver fibrosis in female patients with ultrasonographic-defined MASLD across the spectrum of hypothyroidism by the number of cardiometabolic disorders; G Prevalence of advanced liver fibrosis in male patients with CAP-defined MASLD across the spectrum of hypothyroidism by the number of cardiometabolic disorders; H Prevalence of advanced liver fibrosis in female patients with CAP-defined MASLD across the spectrum of hypothyroidism by the number of cardiometabolic disorders

Fig. 4

Fibrotic burden across the spectrum of hypothyroidism by metabolic dysfunction-associated steatotic liver disease (MASLD) status and cardiometabolic traits in men and women. The term “other risk factors” indicates MASLD individuals with cardiometabolic risk factors that used to define MASLD in the absence of diabetes and overweight/obesity. A Prevalence of significant liver fibrosis in ultrasonographic-defined MASLD across the spectrum of hypothyroidism by cardiometabolic traits in men; B Prevalence of significant liver fibrosis in ultrasonographic-defined MASLD across the spectrum of hypothyroidism by cardiometabolic traits in men in women; C Prevalence of significant liver fibrosis in CAP-defined MASLD across the spectrum of hypothyroidism by cardiometabolic traits in men; D Prevalence of significant liver fibrosis in CAP-defined MASLD across the spectrum of hypothyroidism by cardiometabolic traits in women; E Prevalence of advanced liver fibrosis in ultrasonographic-defined MASLD across the spectrum of hypothyroidism by cardiometabolic traits in men; F Prevalence of advanced liver fibrosis in ultrasonographic-defined MASLD across the spectrum of hypothyroidism by cardiometabolic traits in women; G Prevalence of advanced liver fibrosis in CAP-defined MASLD across the spectrum of hypothyroidism by cardiometabolic traits in men; H Prevalence of advanced liver fibrosis in CAP-defined MASLD across the spectrum of hypothyroidism by cardiometabolic traits in women