Clinical Thyroidology® for the Public
Summaries for the Public from recent articles in Clinical Thyroidology
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HYPOTHYROIDISM
Thyroid disease and liver function
BACKGROUND
Hypothyroidism, or underactive thyroid, is common. Thyroid hormone, usually levothyroxine, is used to treat hypothyroidism. Thyroid hormones play an important role in metabolism, which is how the body produces and stores energy. The liver is a major organ that is involved in producing and storing energy. Thyroid hormone also has effects on liver function. As a result, diseases that impact the thyroid gland such as hypo or hyperthyroidism can contribute to the development of liver problems.
A major liver problem is metabolic dysfunction-associated steatotic liver disease (MASLD). This is a condition where excess fat builds up in the liver and is associated with diabetes, high blood pressure, high cholesterol and obesity. MASLD affects ~30% of people worldwide and has emerged as the most common cause of chronic liver disease, including cirrhosis and liver cancer. Studies have shown a strong association between MASLD and hypothyroidism. This study examines the association between hypothyroidism and the risk of cirrhosis and liver cancer in a group of patients with MASLD.
THE FULL ARTICLE TITLE
Jin X et al. Hypothyroidism and the risk of liver-related events in patients with metabolic dysfunction-associated steatotic liver disease. Clin Mol Hepatol 2026;32(1):353– 367; doi: 10.3350/cmh.2025.0860. PMID: 41321024
SUMMARY OF THE STUDY
This study was conducted in Hong Kong, China. The medical records of a group of patients with MASLD treated between the years 2000 and 2024 were reviewed. Patients in this group with hypothyroidism were identified and thyroid function tests were measured both at baseline and follow-up. The liver-related events that were studied included liver cancer, cirrhosis or liver related death.
A total of 20,478 patients were studied. Hypothyroidism was associated with higher risk of cirrhosis. When hypothyroidism was divided by severity, overt hypothyroidism remained significantly associated with cirrhosis, while subclinical hypothyroidism was not. Compared with patients with normal TSH levels, those with high TSH levels had a 2.49-fold increased risk of developing cirrhosis or liver cancer.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study shows that hypothyroidism is linked with high risk of liver problems, including cirrhosis and liver cancer, in patients who had a diagnosis of MASLD. These data suggest that patients with MASLD should be followed with thyroid function testing to identify these high-risk patients. Further studies are needed to determine how these patients can best be treated to decrease this risk.
— Vibhavasu Sharma,MD, FACE
ATA RESOURCES
Hypothyroidism (Underactive): https://www.thyroid.org/hypothyroidism/
Thyroid Hormone Treatment: https://www.thyroid.org/thyroid-hormone-treatment/
Thyroid Function Tests: https://www.thyroid.org/thyroid-function-tests/
All patients with overt hypothyroidism are usually treated with thyroid hormone pills.
ABBREVIATIONS & DEFINITIONS
Hypothyroidism: a condition where the thyroid gland is underactive and doesn’t produce enough thyroid hormone. Treatment requires taking thyroid hormone pills.
Subclinical Hypothyroidism: a mild form of hypothyroidism where the only abnormal hormone level is an increased TSH. There is controversy as to whether this should be treated or not.
TSH: thyroid stimulating hormone — produced by the pituitary gland that regulates thyroid function; also the best screening test to determine if the thyroid is functioning normally.
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