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Plasma thyroid hormone concentration is associated with hepatic triglyceride content in patients with type 2 diabetes
  1. Fernando Bril1,2,
  2. Sushma Kadiyala1,2,
  3. Paola Portillo Sanchez1,2,
  4. Nishanth E Sunny1,
  5. Diane Biernacki1,2,
  6. Maryann Maximos2,3,
  7. Srilaxmi Kalavalapalli1,
  8. Romina Lomonaco1,2,
  9. Amitabh Suman2,4,
  10. Kenneth Cusi1,2,5,6
  1. 1Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, USA
  2. 2Malcom Randall VAMC, Gainesville, Florida, USA
  3. 3Pediatric Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
  4. 4Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
  5. 5Division of Diabetes, University of Texas Health Science Center at San Antonio, Texas, USA
  6. 6Audie L. Murphy VAMC, San Antonio, Texas, USA
  1. Correspondence to Dr Kenneth Cusi, Division of Endocrinology, Diabetes and Metabolism, University of Florida, 1600 SW Archer Road, Room H-2, Gainesville, FL 32610, USA; Kenneth.Cusi{at}medicine.ufl.edu

Abstract

The underlying mechanisms responsible for the development and progression of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM) are unclear. Since the thyroid hormone regulates mitochondrial function in the liver, we designed this study in order to establish the association between plasma free T4 levels and hepatic triglyceride accumulation and histological severity of liver disease in patients with T2DM and NAFLD. This is a cross-sectional study including a total of 232 patients with T2DM. All patients underwent a liver MR spectroscopy (1H-MRS) to quantify hepatic triglyceride content, and an oral glucose tolerance test to estimate insulin resistance. A liver biopsy was performed in patients with a diagnosis of NAFLD. Patients were divided into 5 groups according to plasma free T4 quintiles. We observed that decreasing free T4 levels were associated with an increasing prevalence of NAFLD (from 55% if free T4≥1.18 ng/dL to 80% if free T4<0.80 ng/dL, p=0.016), and higher hepatic triglyceride accumulation by 1H-MRS (p<0.001). However, lower plasma free T4 levels were not significantly associated with more insulin resistance or more severe liver histology (ie, inflammation, ballooning, or fibrosis). Decreasing levels of plasma free T4 are associated with a higher prevalence of NAFLD and increasing levels of hepatic triglyceride content in patients with T2DM. These results suggest that thyroid hormone may play a role in the regulation of hepatic steatosis and support the notion that hypothyroidism may be associated with NAFLD. No NCT number required.

  • Diabetes Mellitus
  • Insulin
  • Obesity
  • Thyroid Diseases
  • Fatty Liver

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