Internal and Emergency Medicine

, Volume 8, Issue 4, pp 297–305

Is nonalcoholic steatohepatitis associated with a high-though-normal thyroid stimulating hormone level and lower cholesterol levels?

  • Lucia Carulli
  • Stefano Ballestri
  • Amedeo Lonardo
  • Francesca Lami
  • Enrico Violi
  • Luisa Losi
  • Lisa Bonilauri
  • Anna Maria Verrone
  • Maria Rosaria Odoardi
  • Federica Scaglioni
  • Marco Bertolotti
  • Paola Loria
IM - ORIGINAL

DOI: 10.1007/s11739-011-0609-4

Cite this article as:
Carulli, L., Ballestri, S., Lonardo, A. et al. Intern Emerg Med (2013) 8: 297. doi:10.1007/s11739-011-0609-4

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.

Keywords

Cholesterol Insulin resistance Metabolic syndrome NASH Steatosis Thyroid hormones TSH 

List of Abbreviations

Apo

Apolipoprotein

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

BMI

Body Mass Index

HDL

High density lipoprotein

HOMA-IR

Homeostasis model assessment of insulin resistance

IR

Insulin resistance

LDL

Low density lipoprotein

MS

Metabolic syndrome

NAFLD

Nonalcoholic fatty liver disease

NASH

Nonalcoholic steatohepatitis

TSH

Thyroid stimulating hormone

FT3

Free thyroxine

FT4

Free triiodothyronine

Copyright information

© SIMI 2011

Authors and Affiliations

  • Lucia Carulli
    • 1
  • Stefano Ballestri
    • 1
  • Amedeo Lonardo
    • 1
  • Francesca Lami
    • 1
  • Enrico Violi
    • 1
  • Luisa Losi
    • 3
  • Lisa Bonilauri
    • 1
  • Anna Maria Verrone
    • 1
  • Maria Rosaria Odoardi
    • 1
  • Federica Scaglioni
    • 1
  • Marco Bertolotti
    • 2
  • Paola Loria
    • 1
  1. 1.Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, Unit of Internal MedicineUniversity of Modena and Reggio EmiliaModenaItaly
  2. 2.Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, Unit of GeriatricsUniversity of Modena and Reggio EmiliaModenaItaly
  3. 3.Department of Pathology, Azienda Ospedaliero-Universitaria Policlinico di ModenaUniversity of Modena and Reggio EmiliaModenaItaly

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