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Background <p>Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) has emerging major global health problem and is closely linked to metabolic abnormalities. Given, central role of thyroid hormones in lipid metabolism and overall energy balance, and by focusing on thyroid hormone sensitivity rather than hormone levels alone, this study seeks to provide new insights into the role of thyroid hormone resistance in the development of MASLD.</p> Aim <p>To evaluate the relationship between thyroid hormone sensitivity indices and the presence of MASLD in euthyroid adults with Type 2 Diabetes Mellitus.</p> Methods <p>A total of 534 euthyroid participants with T2DM were enrolled at Chettinad Hospital and Research Institute. Participants were divided into two groups based on the presence or absence of MASLD and further categorized into quartiles according to each Indices. Thyroid hormone sensitivity was assessed using multiple indices, including the FT3/ FT4 ratio, TT3RI, TT4RI, TSHI, and TFQI<sub>FT3</sub> and TFQI<sub>FT4</sub>. The associations between indices and MASLD were evaluated using regression analyses.</p> Results <p>MASLD prevalence increased with higher levels of FT3/ FT4 ratio, TT3RI, and TFQI<sub>FT3</sub>. After adjusting for potential confounders, elevated FT3/FT4 and TFQI<sub>FT3</sub> remained independent risk factors for MASLD. The association between FT3/FT4, TFQI<sub>FT3</sub> and MASLD was particularly more pronounced in participants aged ≤ 40&#xa0;years. Mediation analysis suggested that the TyG index partially mediated the relationships between FT3/FT4, TFQI<sub>FT3</sub>, and MASLD.</p> Conclusion <p>Higher FT3/FT4 and TFQI<sub>FT3</sub> levels were strongly associated with the prevalence of MASLD in euthyroid individuals. This relationship was partially mediated by the TyG index, suggesting a role for insulin resistance in linking thyroid hormone sensitivity to MASLD.</p>

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Decoding thyroid: liver cross talk in type 2 diabetes mellitus—an MASLD perspective

  • 期刊论文

  • 发表日期：

    2026年7月7日

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  • Sowmiya Subramani,
  • S. Gayathri,
  • Karpagavel Lakshmanan

摘要

Background

Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) has emerging major global health problem and is closely linked to metabolic abnormalities. Given, central role of thyroid hormones in lipid metabolism and overall energy balance, and by focusing on thyroid hormone sensitivity rather than hormone levels alone, this study seeks to provide new insights into the role of thyroid hormone resistance in the development of MASLD.

Aim

To evaluate the relationship between thyroid hormone sensitivity indices and the presence of MASLD in euthyroid adults with Type 2 Diabetes Mellitus.

Methods

A total of 534 euthyroid participants with T2DM were enrolled at Chettinad Hospital and Research Institute. Participants were divided into two groups based on the presence or absence of MASLD and further categorized into quartiles according to each Indices. Thyroid hormone sensitivity was assessed using multiple indices, including the FT3/ FT4 ratio, TT3RI, TT4RI, TSHI, and TFQIFT3 and TFQIFT4. The associations between indices and MASLD were evaluated using regression analyses.

Results

MASLD prevalence increased with higher levels of FT3/ FT4 ratio, TT3RI, and TFQIFT3. After adjusting for potential confounders, elevated FT3/FT4 and TFQIFT3 remained independent risk factors for MASLD. The association between FT3/FT4, TFQIFT3 and MASLD was particularly more pronounced in participants aged ≤ 40 years. Mediation analysis suggested that the TyG index partially mediated the relationships between FT3/FT4, TFQIFT3, and MASLD.

Conclusion

Higher FT3/FT4 and TFQIFT3 levels were strongly associated with the prevalence of MASLD in euthyroid individuals. This relationship was partially mediated by the TyG index, suggesting a role for insulin resistance in linking thyroid hormone sensitivity to MASLD.