title: Is nonalcoholic steatohepatitis associated with a high-though-normal thyroid stimulating hormone level and lower cholesterol levels?
abstract: Hypothyroidism is associated with the risk of development of the metabolic syndrome (MS) and hypercholesterolemia. Direct evidence that hypothyroidism might be associated with advanced chronic liver disease via nonalcoholic steatohepatitis (NASH) is limited. We studied the relationship between thyroid hormones, thyroid stimulating hormone (TSH), cholesterol, and NASH. In consecutive euthyroid patients with biopsy-proven nonalcoholic fatty liver disease, TSH and thyroid hormone (FT3 and FT4) concentrations were compared in 25 patients with steatosis and 44 non-cirrhotic NASH patients featuring concurrent ballooning, lobular inflammation and steatosis. The MS was diagnosed according to ATP III criteria. A meta-analysis of previously published studies was performed to evaluate whether NASH, compared to simple steatosis, is associated with lower cholesterol levels. At univariate analysis, compared to those with steatosis, patients with NASH have a wider waist, elevated levels of BMI, ALT, AST, fasting insulin, HOMA-IR, ferritin, TSH and a lower serum cholesterol. At stepwise multivariable logistic regression analysis, the independent predictors of NASH are high HOMA and TSH and lower total cholesterol (Model 1); MS and high TSH (Model 2). At meta-analysis, serum total cholesterol levels are significantly lower in predominantly non-cirrhotic NASH than in simple steatosis. This study provides cross-sectional and meta-analytic evidence that, in euthyroid patients, high-though-normal TSH values are independently associated with NASH. Further work is needed to ascertain the role, if any, of lower cholesterol serum levels in assisting in the diagnosis of NASH.
authors.affiliation: Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, Unit of Internal Medicine, University of Modena and Reggio Emilia, Nuovo Ospedale Civile Sant'Agostino Estense, Via Giardini 1355, 41100, Modena, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Carulli
authors.forename: Stefano
authors.initials: S
authors.lastname: Ballestri
authors.forename: Amedeo
authors.initials: A
authors.lastname: Lonardo
authors.forename: Francesca
authors.initials: F
authors.lastname: Lami
authors.forename: Enrico
authors.initials: E
authors.lastname: Violi
authors.forename: Luisa
authors.initials: L
authors.lastname: Losi
authors.forename: Lisa
authors.initials: L
authors.lastname: Bonilauri
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Verrone
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Odoardi
authors.forename: Federica
authors.initials: F
authors.lastname: Scaglioni
authors.forename: Marco
authors.initials: M
authors.lastname: Bertolotti
authors.forename: Paola
authors.initials: P
authors.lastname: Loria
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood*; D005234:Fatty Liver / Q000097:blood* / Q000175:diagnosis; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008111:Liver Function Tests; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D012307:Risk Factors; D013972:Thyrotropin / Q000097:blood*; D018084:Ultrasonography, Interventional; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D007328:Insulin; D013972:Thyrotropin; D005293:Ferritins; D002784:Cholesterol