Menopause, Hypothyroidism, and Metabolic Dysfunction-associated Steatotic Liver Disease: An Interconnected Triad

ARTICLE(24 cross-sectional and 4 longitudinal studies with aggregate data on ~76.5 million individuals) demonstrate a strong association between primary hypothyroidism and both the presence and histopathological progression of MASLD. 3 The coexistence of hypothyroidism and menopause can worsen symptoms and complicate treatment.Women suffering from hypothyroidism may experience weight gain, fatigue, and depression, symptoms that are often similar or overlapping with those of menopause.Such symptom overlap can present IntroductIonMenopause represents a major transitional period in a woman's life, defined by the end of menstruation and accompanied by a variety of physiological changes driven by hormonal shifts.This stage, which typically occurs between the ages of 45 and 55, is often accompanied by a range of symptoms, such as hot flashes, mood fluctuations, and sleep disturbances.However, menopause does not exist in isolation; it intersects with other health conditions that can amplify health risks, such as hypothyroidism and metabolic dysfunction-associated steatotic liver disease (MASLD). 1 Hypothyroidism, resulting from inadequate hormone production by the thyroid, is often seen in postmenopausal women.Thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3), are essential for regulating metabolism, maintaining energy balance, and supporting overall hormonal equilibrium.As women age and transition through menopause, fluctuations in sex hormone levels can significantly impact thyroid function.Studies suggest that the risk of developing hypothyroidism increases after menopause, potentially due to autoimmune processes, such as Hashimoto's thyroiditis, which can lead to the destruction of thyroid tissue. 2 Metabolic dysfunction-associated steatotic liver disease risk sharply increases around the average age of menopause, but the exact association between the age at menopause and MASLD is unclear.Recent large and updated meta-analyses