J Korean Endocr Soc.  2009 Jun;24(2):87-92. 10.3803/jkes.2009.24.2.87.

Free T4 is Negatively Correlated with Non-alcoholic Fatty Liver Disease in Euthyroid Women

• Jun EJ
• Kim HS
• Chung HK
• Lee JH
• Kim SR
• Jung ED

• KMID: 1468502
• DOI: http://doi.org/10.3803/jkes.2009.24.2.87

Abstract

BACKGROUND: Thyroid hormones play an important role in the regulation of lipid and carbohydrate metabolism and the body mass index (BMI), which all affect non-alcoholic fatty liver disease (NAFLD). In a previous study, we demonstrated that free T4 was negatively associated with the BMI in euthyroid women. However, there is still uncertain as to whether the thyroid function within the normal range is associated with NAFLD and liver function abnormalities. We sought to evaluate the thyroid function (free T4, TSH) and its possible relationship with NAFLD in euthyroid women.
METHODS
A total of 835 euthyroid, non heavy alcoholics women who visited the Daegu Catholic University University Medical Centre for primary health screening from January 1, 2006 to December 31, 2006 participated in this cross-sectional study. The women who were not euthyroid or heavy alcoholics (> 70 g/week in women according to the DSM-IV), there was no known history of diabetes mellitus, the fasting blood glucose was more than 5.55 mmol/L and those who had viral hepatitis were excluded. Hepatic ultrasonography scanning was performed in all the participants by a single experienced radiologist. The TSH, free T4, BP, fasting glucose, serum liver enzymes (AST, ALT, GGT, T-bilirubin), lipid profiles [total-cholesterol, triglyceride (TG), HDL-C, LDL-C] and NAFLD were evaluated.
RESULTS
Euthyroid women with NAFLD had lower free T4 levels than did the euthyroid women without NAFLD. After adjustment for age and BMI, free T4 was negatively correlated with TG, but free T4 was positively correlated with the total serum bilirubin. Free T4 was not correlated with the serum AST, ALT and GGT. After adjustment for age, the BMI, the fasting glucose, the GGT and free T4, but not TSH, were significantly negatively correlated with NAFLD.
CONCLUSION
We demonstrated a negative correlation between free T4 and NAFLD in euthyroid women. This finding suggests lower levels of free T4 is associated with NAFLD in euthyroid subjects.

Keyword

body mass index; free T4; non-alcoholic fatty liver disease; triglyceride

MeSH Terms

Alcoholics
Bilirubin
Blood Glucose
Body Mass Index
Carbohydrate Metabolism
Cross-Sectional Studies
Diabetes Mellitus
Fasting
Fatty Liver
Female
Glucose
Hepatitis
Humans
Liver
Mass Screening
Reference Values
Thyroid Gland
Thyroid Hormones
Bilirubin
Blood Glucose
Fatty Liver
Glucose
Thyroid Hormones

Reference

1. Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, Musso A, De Paolis P, Capussotti L, Salizzoni M, Rizzetto M. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002. 123:134–140.

2. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003. 98:960–967.

3. Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Tani S, Goto M. Prevalence of fatty liver in a general population of Okinawa, Japan. Jpn J Med. 1988. 27:142–149.

4. Ko ES, Shin JH, Kang EY, Hwang YN, Seo AR, Song SW. Relationship between non-alcoholic fatty liver disease and metabolic syndrome in examiners of a Health Promotion Center in Kyeong-ki do. Korean J Obes. 2008. 17:37–44.

5. Seo SH, Lee HW, Park HW, Jang BG, Chung WJ, Park KS, Cho KB, Hwang JS, Ahn SH. Prevalence and associated factors of nonalcoholic fatty liver disease in the health screen examinees. Korean J Med. 2006. 70:26–32.

6. Fan JG, Zhu J, Li XJ, Chen L, Li L, Dai F, Li F, Chen SY. Prevalence of and risk factors for fatty liver in a general population of Shanghai, China. J Hepatol. 2005. 43:508–514.

7. Lee S, Jin Kim Y, Yong Jeon T, Hoi Kim H, Woo Oh S, Park Y, Soo Kim S. Obesity is the only independent factor associated with ultrasound-diagnosed non-alcoholic fatty liver disease: a cross-sectional case-control study. Scand J Gastroenterol. 2006. 41:566–572.

8. L'Age M, Meinhold H, Wenze KW, Schleusener H. Relations between serum levels of TSH, TBG, T4, T3, rT3 and various histologically classified chronic liver diseases. J Endocrinol Invest. 1980. 3:379–383.

9. Liangpunsakul S, Chalasani N. Is hypothyroidism a risk factor for non-alcoholic steatohepatitis? J Clin Gastroenterol. 2003. 37:340–343.

10. Shon HS, Jung ED, Kim SH, Lee JH. Free T4 is negatively correlated with body mass index in euthyroid women. Korean J Intern Med. 2008. 23:53–57.

11. Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Ann Intern Med. 1997. 126:137–145.

12. Johansson L, Rudling M, Scanlan TS, Lundasen T, Webb P, Baxter J, Angelin B, Parini P. Selective thyroid receptor modulation by GC-1 reduces serum lipids and stimulates steps of reverse cholesterol transport in euthyroid mice. Proc Natl Acad Sci USA. 2005. 102:10297–10302.

13. Perra A, Simbula G, Simbula M, Pibiri M, Kowalik MA, Sulas P, Cocco MT, Ledda-Columbano GM, Columbano A. Thyroid hormone (T3) and TRbeta agonist GC-1 inhibit/reverse nonalcoholic fatty liver in rats. FASEB J. 2008. 22:2981–2989.

14. Roos A, Bakker SJ, Links TP, Gans RO, Wolffenbuttel BH. Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab. 2007. 92:491–496.

15. Kim BJ, Kim TY, Koh JM, Kim HK, Park JY, Lee KU, Shong YK, Kim WB. Relationship between serum free T4 (FT4) levels and metabolic syndrome (MS) and its components in healthy euthyroid subjects. Clin Endocrinol (Oxf). 2009. 70:152–160.

16. Targher G, Montagnana M, Salvagno G, Moghetti P, Zoppini G, Muggeo M, Lippi G. Association between serum TSH, free T4 and serum liver enzyme activities in a large cohort of unselected outpatients. Clin Endocrinol (Oxf). 2008. 68:481–484.