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已发表论文
甲状腺功能正常者甲状腺激素敏感性与非酒精性脂肪肝疾病之间的关联
Authors Xu T, Han T, Zhai J, Qiao H
Received 23 June 2025
Accepted for publication 6 September 2025
Published 20 September 2025 Volume 2025:18 Pages 3575—3588
DOI https://doi.org/10.2147/DMSO.S538911
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Jae Woong Sull
Tingting Xu,1 Tianshu Han,2 Jingyu Zhai,3 Hong Qiao1
1Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150000, People’s Republic of China; 2The National Key Discipline, Department of Nutrition and Food Hygiene, Public Health College, Harbin medical university, Harbin, Heilongjiang, 150000, People’s Republic of China; 3Department of Endocrinology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, 161000, People’s Republic of China
Correspondence: Hong Qiao, Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150000, People’s Republic of China, Email qiaohong@hrbmu.edu.cn
Introduction: Nonalcoholic fatty liver disease (NAFLD) is a globally prevalent metabolic disorder that has attracted increasing clinical and public health attention. Although several studies have suggested a potential link between thyroid hormone levels and the risk of NAFLD, existing epidemiological evidence remains limited and inconsistent. Therefore, this study aims to investigate the association between thyroid hormone sensitivity and NAFLD in individuals with normal thyroid function. Furthermore, we sought to explore whether this association differs according to the presence or absence of metabolic comorbidities, particularly type 2 diabetes mellitus (T2DM) and non-diabetic (non-DM) status.
Methods: We included 460 adults with normal thyroid function, comprising 229 patients with T2DM and 231 without diabetes. Steatosis was assessed using liver ultrasonography.
Results: Both the thyroid feedback quantile index based on free thyroxine (TFQI-FT4) and that based on free triiodothyronine (TFQI-FT3) were positively associated with the presence of NAFLD (Q4 vs Q1, Model 3: TFQI-FT4, OR = 3.290, 95% CI: 1.390– 7.787, p = 0.007; TFQI-FT3, OR = 2.344, 95% CI: 1.010– 5.439, p = 0.047). Among individuals with type 2 diabetes mellitus (T2DM), a higher FT3/FT4 ratio was associated with a lower risk of NAFLD (Q3 vs Q1, Model 2: OR = 0.221, 95% CI: 0.053– 0.921, p = 0.038), although the comparison between Q4 and Q1 did not reach statistical significance (OR = 0.402, 95% CI: 0.100– 1.614, p = 0.199). In contrast, among non-diabetic individuals, a higher FT3/FT4 ratio was positively associated with NAFLD (Q4 vs Q1, Model 2: OR = 3.390, 95% CI: 1.003– 11.463, p = 0.049).
Conclusion: Thyroid hormone sensitivity is associated with the development of NAFLD development in individuals with normal thyroid function and may be influenced by the presence of T2DM.
Keywords: thyroid hormone sensitivity, thyroid hormone central sensitivity, thyroid hormone peripheral sensitivity, NAFLD, T2DM
1Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150000, People’s Republic of China; 2The National Key Discipline, Department of Nutrition and Food Hygiene, Public Health College, Harbin medical university, Harbin, Heilongjiang, 150000, People’s Republic of China; 3Department of Endocrinology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, 161000, People’s Republic of China
Correspondence: Hong Qiao, Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150000, People’s Republic of China, Email qiaohong@hrbmu.edu.cn
Introduction: Nonalcoholic fatty liver disease (NAFLD) is a globally prevalent metabolic disorder that has attracted increasing clinical and public health attention. Although several studies have suggested a potential link between thyroid hormone levels and the risk of NAFLD, existing epidemiological evidence remains limited and inconsistent. Therefore, this study aims to investigate the association between thyroid hormone sensitivity and NAFLD in individuals with normal thyroid function. Furthermore, we sought to explore whether this association differs according to the presence or absence of metabolic comorbidities, particularly type 2 diabetes mellitus (T2DM) and non-diabetic (non-DM) status.
Methods: We included 460 adults with normal thyroid function, comprising 229 patients with T2DM and 231 without diabetes. Steatosis was assessed using liver ultrasonography.
Results: Both the thyroid feedback quantile index based on free thyroxine (TFQI-FT4) and that based on free triiodothyronine (TFQI-FT3) were positively associated with the presence of NAFLD (Q4 vs Q1, Model 3: TFQI-FT4, OR = 3.290, 95% CI: 1.390– 7.787, p = 0.007; TFQI-FT3, OR = 2.344, 95% CI: 1.010– 5.439, p = 0.047). Among individuals with type 2 diabetes mellitus (T2DM), a higher FT3/FT4 ratio was associated with a lower risk of NAFLD (Q3 vs Q1, Model 2: OR = 0.221, 95% CI: 0.053– 0.921, p = 0.038), although the comparison between Q4 and Q1 did not reach statistical significance (OR = 0.402, 95% CI: 0.100– 1.614, p = 0.199). In contrast, among non-diabetic individuals, a higher FT3/FT4 ratio was positively associated with NAFLD (Q4 vs Q1, Model 2: OR = 3.390, 95% CI: 1.003– 11.463, p = 0.049).
Conclusion: Thyroid hormone sensitivity is associated with the development of NAFLD development in individuals with normal thyroid function and may be influenced by the presence of T2DM.
Keywords: thyroid hormone sensitivity, thyroid hormone central sensitivity, thyroid hormone peripheral sensitivity, NAFLD, T2DM