Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China.
J Clin Endocrinol Metab. 2023 Jun 16;108(7):e434-e443. doi: 10.1210/clinem/dgad016.
Thyroid function variation within the thyroxine reference range has negative metabolic effects. Metabolic dysfunction-associated fatty liver disease (MAFLD) is a recently proposed definition.
We aim to explore the effects of thyroid function status on prevalence and mortality of MAFLD.
Data of 10 666 participants from the Third National Health and Nutrition Examination Survey (NHANES III) were used. MAFLD was diagnosed based on the new definition. Thyroid function variation within the thyroxine reference range was defined based on thyroid-stimulating hormone (TSH) levels: subclinical hyperthyroidism, <0.39 mIU/L; strict-normal thyroid function, 0.39-2.5 mIU/L; and low thyroid function, >2.5 mIU/L, which comprised low-normal thyroid function (2.5-4.5 mIU/L) and subclinical hypothyroidism (> 4.5 mIU/L). Logistic and Cox regression were used in multivariate analysis.
Low thyroid function is independently associated with MAFLD (odds ratio: 1.27). Compared with strict-normal thyroid function, subclinical hypothyroidism was significantly associated with increased risk for all-cause and cardiovascular mortality in the total population (hazard ratio [HR] for all-cause: 1.23; cardiovascular: 1.65) and MAFLD population (HR for all-cause: 1.32; cardiovascular: 1.99); meanwhile, in the low-normal thyroid function group, an increasing trend in mortality risk was observed. Furthermore, low thyroid function also showed significant negative impact on mortality in the total and MAFLD population. Among thyroid function spectrum, mild subclinical hypothyroidism showed the highest HRs on mortality.
Low thyroid function is independent risk factor of MAFLD and is associated with increased risk for all-cause and cardiovascular mortality in the MAFLD population. Reevaluation of TSH reference range should be considered.
甲状腺素参考范围内的甲状腺功能变化具有负面的代谢影响。代谢相关脂肪性肝病（MAFLD）是最近提出的一种定义。
我们旨在探讨甲状腺功能状态对 MAFLD 的患病率和死亡率的影响。
使用来自第三次全国健康和营养检查调查（NHANES III）的 10666 名参与者的数据。根据新定义诊断 MAFLD。甲状腺素参考范围内的甲状腺功能变化基于促甲状腺激素（TSH）水平定义：亚临床甲状腺功能亢进症，<0.39 mIU/L；严格正常甲状腺功能，0.39-2.5 mIU/L；甲状腺功能低下，>2.5 mIU/L，包括正常低值甲状腺功能（2.5-4.5 mIU/L）和亚临床甲状腺功能减退症（>4.5 mIU/L）。使用逻辑回归和 Cox 回归进行多变量分析。
甲状腺功能低下与 MAFLD 独立相关（比值比：1.27）。与严格正常甲状腺功能相比，亚临床甲状腺功能减退症与全人群（全因死亡风险比[HR]：1.23；心血管：1.65）和 MAFLD 人群（全因死亡风险比[HR]：1.32；心血管：1.99）的全因和心血管死亡风险显著增加相关；同时，在正常低值甲状腺功能组中，观察到死亡率风险呈增加趋势。此外，甲状腺功能低下也对全人群和 MAFLD 人群的死亡率有显著的负面影响。在甲状腺功能谱中，轻度亚临床甲状腺功能减退症的死亡率 HR 最高。
甲状腺功能低下是 MAFLD 的独立危险因素，与 MAFLD 人群的全因和心血管死亡风险增加相关。应考虑重新评估 TSH 参考范围。
