Relationship between impaired sensitivity to thyroid hormones and MAFLD with elevated liver enzymes in the euthyroid population

Abstract Aims To investigate the association between thyroid hormone sensitivity and metabolic dysfunction-associated fatty liver disease (MAFLD) with elevated liver enzymes in the euthyroid populations. Methods A total of 3929 euthyroid adults from the Second Affiliated Hospital of Nanchang University were included in this study. Thyroid hormone sensitivity indices were calculated by thyroid feedback quantile-based index (TFQI), TSH index (TSHI) and thyrotropin thyroxine resistance index (TT4RI). Associations between thyroid hormones sensitivities and risk of MAFLD, MAFLD with elevated liver enzymes, MAFLD with elevated free fatty acid (FFAs) were assessed with logistic regression. Results After adjustment for multiple risk factors, odd ratios (ORs) of the fourth versus the first TFQI FT4 quartile for MAFLD, MAFLD with elevated liver enzymes, and MAFLD with elevated FFAs were 1.778 (95% CI 1.378, 2.293), 1.466 (1.105, 1.945), and 1.936 (1.479, 2.534), respectively (all p < 0.001). Per 1 SD in TFQI FT4 , ORs increased 2.27 (95% CI 1.74, 2.97) for MAFLD, 2.05 (1.51, 2.78) for MAFLD with elevated liver enzymes, and 2.43 (1.82, 3.24) for MAFLD with elevated FFAs. The other sensitivity to thyroid hormones indices showed similar associations for MAFLD and MAFLD with elevated liver enzymes. Conclusions Impaired sensitivity to thyroid hormone in euthyroid population is associated with MAFLD, MAFLD with elevated liver enzymes, T2DM, hyperuricemia, elevated liver enzymes, and MAFLD with elevated FFAs. TFQI FT4 , TFQI FT3 , TSHI and TT4RI can be used as new indicators for predicting MAFLD and MAFLD with elevated liver enzymes, While TFQI FT3 performed better than the other three indexes.