Thyroid function, adipokines and mitokines in metabolic dysfunction‐associated steatohepatitis: A multi‐centre biopsy‐based observational study.

Background and Aims: Thyroid axis is currently under investigation as a therapeutic target in metabolic dysfunction‐associated steatotic liver disease (MASLD). Thyroid function was examined herein in the full spectrum of disease. Methods: Subjects were recruited and had liver biopsies in two Gastroenterology‐Hepatology Clinics (Greece and Australia) and one Bariatric‐Metabolic Surgery Clinic (Italy). The main working sample was n = 677 subjects with MASLD after excluding subjects with abnormal free thyroxine levels. Participants were classified according to thyroid‐stimulating hormone (TSH) standard criteria: Subclinical hyperthyroidism (<0.4 uIU/mL); Euthyroidism with relatively low (0.4 to <2.5 uIU/mL); euthyroidism with relatively high (2.5–4.0 uIU/mL); subclinical hypothyroidism (>4 uIU/mL). Results: TSH as a continuous variable was positively associated with significant fibrosis (F ≥ 2), metabolic dysfunction‐associated steatohepatitis (MASH) and at‐risk MASH. Subclinical hypothyroidism was associated with fibrosis F ≥ 2 (odds ratio [OR] = 3.47, 95% confident interval [CI] [1.50, 8.05], p =.02), MASH (OR = 3.44, 95% CI [1.48, 7.98] p =.001) and at‐risk MASH (OR = 3.88, 95% CI [1.76, 8.55], p =.001), before and after controlling for adiposity, central obesity, and insulin resistance. When leptin, adiponectin, or growth differentiation factor‐15 were examined as moderators, significance was lost. Sex‐specific analysis revealed a strong association between TSH and the presence of significant fibrosis among women, eliminated only when adipokines/mitokines were adjusted for. Restricted cubic spline analysis revealed associations between TSH and liver outcomes (p‐values <.01) with inflection points for fibrosis F ≥ 2 being 2.49, for MASH being 2.67 and for at‐risk MASH being 6.96. Conclusions: These observations provide support for studies on the administration of thyroid hormone in MASLD therapeutics for subclinical hypothyroidism and liver‐specific thyroid receptor agonists for subjects across the TSH continuum. [ABSTRACT FROM AUTHOR]