{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:56:00Z","timestamp":1792810560043,"version":"4.5.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100021546","name":"Suez University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100021546","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Metabolic dysfunction associated fatty liver disease (MAFLD) is a common metabolic disorder intricately linked to diabetes and thyroid dysfunction. Hypothyroidism, characterized by elevated thyroid-stimulating hormone (TSH), may disrupt lipid metabolism and exacerbate insulin resistance, contributing to MAFLD progression. Investigating the combined impact of diabetes and thyroid dysfunction on fibrosis and steatosis stages in MAFLD is essential for optimizing disease management. This prospective cross-sectional study was conducted at Suez General Hospital from March to September 2024 and included 400 patients with MAFLD\n                    <jats:bold>.<\/jats:bold>\n                    Participants were stratified into four groups: Group A: 100 diabetic patients without thyroid dysfunction; Group B: 100 non-diabetic patients without thyroid dysfunction; Group C: 100 diabetic patients with thyroid dysfunction; and Group D: 100 non-diabetic patients with thyroid dysfunction. Clinical assessment, laboratory investigations, fibrosis-4 (FIB-4) scores, and abdominal ultrasonography were performed for all participants, and transient elastography (FibroScan\n                    <jats:sup>\u00ae<\/jats:sup>\n                    ) for those with FIB-4 scores\u2009&gt;\u20093.25. Significant differences were observed in the distribution of body mass index (BMI), liver enzymes, and fibrosis stages across the groups (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001, for all). Group C exhibited the highest prevalence of advanced fibrosis (F2\u2013F3), while severe steatosis (S3) was predominant in Group D. Hypothyroidism and subclinical hypothyroidism were associated with elevated FIB-4 scores and advanced steatosis (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.033), highlighting the impact of thyroid dysfunction on MAFLD progression. Diabetes and thyroid dysfunction can exacerbate MAFLD severity, emphasizing the need for integrated management strategies targeting these comorbidities to mitigate fibrosis and steatosis progression.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-28232-x","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T05:19:02Z","timestamp":1765775942000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of thyroid dysfunction and diabetes on fibrosis and steatosis stages in metabolic dysfunction associated fatty liver disease"],"prefix":"10.1038","volume":"15","author":[{"given":"Mohamed W.","family":"Saleh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maysa I.","family":"Farghly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Elsebaie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nessren","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"El-Mankhly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"28232_CR1","doi-asserted-by":"publisher","unstructured":"Tanase, D. M. et al. Hypothyroidism-induced nonalcoholic fatty liver disease (Hin): Mechanisms and emerging therapeutic options. Int. J. Mol. Sci. 21(16),1\u201329. MDPI AG. (2020). https:\/\/doi.org\/10.3390\/ijms21165927(","DOI":"10.3390\/ijms21165927("},{"issue":"5","key":"28232_CR2","doi-asserted-by":"publisher","first-page":"641","DOI":"10.4254\/WJH.V15.I5.641","volume":"15","author":"B Janota","year":"2023","unstructured":"Janota, B., Szczepa\u0144ska, E., Adamek, B. & Janczewska, E. Hypothyroidism and non-alcoholic fatty liver disease: A coincidence or a causal relationship? World J. Hepatol. 15 (5), 641\u2013648. https:\/\/doi.org\/10.4254\/WJH.V15.I5.641 (2023).","journal-title":"World J. Hepatol."},{"key":"28232_CR3","doi-asserted-by":"publisher","unstructured":"Vidal-Cevallos, P., Mur\u00faa-Beltr\u00e1n Gall, S., Uribe, M. & Ch\u00e1vez-Tapia, N. C. Understanding the relationship between nonalcoholic fatty liver disease and thyroid disease. Int. J. Mol. Sci. 24(19) https:\/\/doi.org\/10.3390\/ijms241914605( (2023). InMultidisciplinary Digital Publishing Institute (MDPI).","DOI":"10.3390\/ijms241914605("},{"key":"28232_CR4","doi-asserted-by":"publisher","unstructured":"Fan, H. et al. Low thyroid function is associated with an increased risk of advanced fibrosis in patients with metabolic dysfunction-associated fatty liver disease. BMC Gastroenterol. 23(1). https:\/\/doi.org\/10.1186\/s12876-022-02612-3(2023).","DOI":"10.1186\/s12876-022-02612-3(2023"},{"issue":"3","key":"28232_CR5","doi-asserted-by":"publisher","first-page":"551","DOI":"10.4254\/wjh.v14.i3.551","volume":"14","author":"A Almomani","year":"2022","unstructured":"Almomani, A. et al. Prevalence of hypothyroidism and effect of thyroid hormone replacement therapy in patients with non-alcoholic fatty liver disease: A population-based study. World J. Hepatol. 14 (3), 551\u2013558. https:\/\/doi.org\/10.4254\/wjh.v14.i3.551 (2022).","journal-title":"World J. Hepatol."},{"key":"28232_CR6","doi-asserted-by":"publisher","unstructured":"Lonardo, A. et al. Nonalcoholic fatty liver disease: Evolving paradigms. World J. Gastroenterol. 23(36), 6571\u20136592. Baishideng Publishing Group Co. (2017). https:\/\/doi.org\/10.3748\/wjg.v23.i36.6571","DOI":"10.3748\/wjg.v23.i36.6571"},{"issue":"46","key":"28232_CR7","doi-asserted-by":"publisher","first-page":"e17945","DOI":"10.1097\/MD.0000000000017945","volume":"98","author":"L Liu","year":"2019","unstructured":"Liu, L. et al. Thyroid-stimulating hormone is associated with nonalcoholic steatohepatitis in patients with chronic hepatitis B. Medicine 98 (46), e17945. https:\/\/doi.org\/10.1097\/MD.0000000000017945 (2019).","journal-title":"Medicine"},{"key":"28232_CR8","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.14858","author":"R Gor","year":"2021","unstructured":"Gor, R. et al. Unraveling the role of hypothyroidism in non-alcoholic fatty liver disease pathogenesis: Correlations, conflicts, and the current stand. Cureus https:\/\/doi.org\/10.7759\/cureus.14858 (2021).","journal-title":"Cureus"},{"key":"28232_CR9","doi-asserted-by":"publisher","unstructured":"Krashin, E., Piekie\u0142ko-Witkowska, A., Ellis, M. & Ashur-Fabian, O. Thyroid hormones and cancer: A comprehensive review of preclinical and clinical studies. Front. Endocrinol. 10(FEB) (2019). https:\/\/doi.org\/10.3389\/fendo.2019.00059","DOI":"10.3389\/fendo.2019.00059"},{"key":"28232_CR10","doi-asserted-by":"publisher","unstructured":"Labenz, C., Kostev, K., Armandi, A., Galle, P. R. & Schattenberg, J. M. Impact of thyroid disorders on the incidence of non-alcoholic fatty liver disease in Germany. United European Gastroenterol. J. 9(7), 829\u2013836 (2021). https:\/\/doi.org\/10.1002\/ueg2.12124. Epub 2021 Jul 20. PMID: 34288580; PMCID: PMC8435260.(2021).","DOI":"10.1002\/ueg2.12124"},{"key":"28232_CR11","unstructured":"Le, M. et al. NAFLD Prevalence: A systematic review and meta-analysis. Clin. Gastroenterol. Hepatol. 20, 2809\u20132017 (2019)."},{"key":"28232_CR12","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1002\/hep.31296","volume":"72","author":"MJ Ritter","year":"2020","unstructured":"Ritter, M. J., Amano, I. & Hollenberg, A. Thyroid hormone signaling and the liver. Hepatology 72, 742\u2013752 (2020).","journal-title":"Hepatology"},{"key":"28232_CR13","doi-asserted-by":"crossref","unstructured":"Fan, H. et al. Low thyroid function is associated with an increased risk of advanced fibrosis in patients with metabolic dysfunction-associated fatty liver disease. BMC Gastroenterol. 23, 30\u201340 (2023).","DOI":"10.1186\/s12876-022-02612-3"},{"key":"28232_CR14","doi-asserted-by":"crossref","unstructured":"Zambrano, R. et al. Diagnostic performance of three non-invasive fibrosis scores (Hepamet, FIB-4, NAFLD fibrosis score) in NAFLD patients from a mixed Latin American population. Ann Hepatol. 19, 622\u2013626 (2020).","DOI":"10.1016\/j.aohep.2020.08.066"},{"key":"28232_CR15","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1007\/s12020-022-03279-2","volume":"80","author":"X Zhang","year":"2023","unstructured":"Zhang, X. et al. Correlation between thyroid function, sensitivity to thyroid hormones and metabolic dysfunction-associated fatty liver disease in euthyroid subjects with newly diagnosed type 2 diabetes. Endocrine 80, 366\u2013379 (2023). 2023.","journal-title":"Endocrine"},{"key":"28232_CR16","doi-asserted-by":"crossref","unstructured":"Halaoui, A., Ali, A., Habib, S., Kanso, M. & Daniel, F. Mukher,j. Gender differences in liver fibrosis among patients younger than 50 years: A retrospective cohort study. Clin. Res. Hepatol. Gastroenterol. 44, 733\u2013738 (2020).","DOI":"10.1016\/j.clinre.2020.01.001"},{"key":"28232_CR17","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.cgh.2020.04.067","volume":"19","author":"M Balakrishnan","year":"2021","unstructured":"Balakrishnan, M. et al. Women have a lower risk of nonalcoholic fatty liver disease but a higher risk of progression vs men: A systematic review and Meta-analysis. Clin. Gastroenterol. Hepatol. 19, 61\u201371 (2021).","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"28232_CR18","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3390\/ijms24032771","volume":"24","author":"P Vidal","year":"2023","unstructured":"Vidal, P., Mur\u00faa, G., Uribe, M. & Ch\u00e1vez, N. Understanding the relationship between nonalcoholic fatty liver disease and thyroid disease. Int. J. Mol. Sci. 24, 24\u201336 (2023). (2023).","journal-title":"Int. J. Mol. 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