Association between Thyroid-Stimulating Hormone and Insulin Resistance among Patients with Metabolic Associated Fatty Liver Disease (MAFLD)

Background: Subclinical hypothyroidism (SCH), characterized by elevated TSH and normal free T4 levels, has been implicated in metabolic disorders including insulin resistance (IR). This study investigates the relationship between thyroid stimulating hormone (TSH) levels and IR as measured by HOMA-IR in patients with metabolic-associated fatty liver disease (MAFLD). Aim of the work: to clarify relation between thyroid stimulating hormones and insulin resistance in MAFLD patients. Methods: A cross-sectional analytical study was conducted on a cohort of MAFLD patients recruited from Minia University Hospital’s Hepatology and Gastroenterology outpatient clinic. It included 180 MAFLD patients who were divided according to thyroid function into subclinical hypothyroid and euthyroid groups. All participtants were subjected to clinical examination, anthropometric data, thyroid profile, liver enzymes, lipid profiles, fasting insulin and fasting glucose assessment with calculation of HOMA-IR and hepatic steatosis index (HSI) was calculated for determine grade of steatosis. Results: the study revealed that subclinical hypothyroid patients had higher mean fasting insulin levels and HOMA-IR scores compared to euthyroid patients (p < 0.05). TSH levels showed a statistically significant positive correlation with HOMA-IR among the entire cohort (r = [0.6], p < 0.001), and particularly within the SCH group (r = [0.8], p < 0.001). Conclusion: Elevated TSH levels are associated with increased insulin resistance among MAFLD patients, especially in those with subclinical hypothyroidism. These findings suggest that hypothyroidism even subclinical type may play a contributory role in metabolic dysregulation in initiation and progression of MAFLD and highlight the importance of thyroid screening in those patients.