{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:40:12Z","timestamp":1789400412356,"version":"build-2803163510"},"reference-count":100,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non-alcoholic fatty liver disease (NAFLD) and hypothyroidism are both prevalent conditions with potential reciprocal influences. This study evaluates the link between NAFLD and hypothyroidism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was performed using Scopus, PubMed, Web of Science, and Google Scholar. A random-effects meta-analysis assessed the bidirectional connection between hypothyroidism and NAFLD. Subgroup, meta-regression, and sensitivity analyses explored variability. R software (version 4.4.1) was employed for all analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data from 38,877,762 people were assessed, with 99% being female, limiting generalizability to male populations. Among the study population, females were significantly more numerous than males. Hypothyroidism increased the presence of NAFLD and nonalcoholic steatohepatitis (NASH) (OR = 1.96, 95% CI\u2009=\u20091.34\u20132.87; I2\u2009=\u200989%). In subgroup analysis, the incidence of NAFLD\/NASH was increased in both subclinical and unspecified hypothyroidism patients (OR = 1.59, 95% CI\u2009=\u20091.08\u20132.35; I2\u2009=\u200991%, and OR = 1.96, 95% CI\u2009=\u20091.09\u20133.54; I2\u2009=\u200979%, respectively). Conversely, overt hypothyroidism did not significantly increase the risk of NAFLD\/NASH (OR = 4.27, 95% CI\u2009=\u20090.90\u201320.19; I2\u2009=\u200989%). Additionally, NAFLD patients were more likely to develop hypothyroidism (OR = 1.85, 95% CI\u2009=\u20091.35\u20132.53; I2\u2009=\u2009100%). According to the subgroup analysis, NAFLD patients were more prone to develop subclinical hypothyroidism (OR = 1.83, 95% CI\u2009=\u20091.11\u20133.03; I2\u2009=\u200987%). The increased presence of overt hypothyroidism wasn\u2019t found to be significant in NAFLD patients (OR = 1.94, 95% CI\u2009=\u20090.73\u20135.18).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggests a reciprocal connection between hypothyroidism and NAFLD, underscoring the need for integrated management strategies and additional research into the underlying mechanisms. The predominance of female participants, combined with high heterogeneity, limits the applicability of findings to broader populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0338413","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T18:34:06Z","timestamp":1766082846000},"page":"e0338413","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["The reciprocal relationship between non-alcoholic fatty liver disease and hypothyroidism: A systematic review and meta-analysis of about 39 million individuals"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4363-8010","authenticated-orcid":true,"given":"Ariyan","family":"Ayati Firoozabadi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Elahi Vahed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pouyan","family":"Lotfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel","family":"Geshani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Keshavarzian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Moftakhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahkameh","family":"Razaghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Rasouli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahtab","family":"Montazeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Ali","family":"Mansournia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massoud","family":"Vosough","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0024-1934","authenticated-orcid":true,"given":"Mohammad","family":"Rahmanian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"pone.0338413.ref001","article-title":"Global incidence and prevalence of nonalcoholic fatty liver disease","volume":"29","author":"ML Teng","year":"2023","journal-title":"Clin Mol Hepatol"},{"issue":"24","key":"pone.0338413.ref002","doi-asserted-by":"crossref","DOI":"10.3390\/ijms21249646","article-title":"Nonalcoholic fatty liver disease and non-alcoholic steatohepatitis: current issues and future perspectives in preclinical and clinical research","volume":"21","author":"C Berardo","year":"2020","journal-title":"Int J Mol Sci"},{"issue":"4","key":"pone.0338413.ref003","first-page":"884","article-title":"Non-alcoholic fatty liver disease, metabolic syndrome, and type 2 diabetes mellitus: where do we stand today?","volume":"19","author":"B Mitrovic","year":"2022","journal-title":"Arch Med Sci"},{"issue":"6","key":"pone.0338413.ref004","doi-asserted-by":"crossref","first-page":"100192","DOI":"10.1016\/j.jhepr.2020.100192","article-title":"NAFLD and liver transplantation: disease burden, current management and future challenges","volume":"2","author":"P Burra","year":"2020","journal-title":"JHEP Rep"},{"key":"pone.0338413.ref005","doi-asserted-by":"crossref","first-page":"100149","DOI":"10.1016\/j.metop.2021.100149","article-title":"Metabolic causes and consequences of nonalcoholic fatty liver disease (NAFLD)","volume":"12","author":"P Zarghamravanbakhsh","year":"2021","journal-title":"Metabol Open"},{"issue":"20","key":"pone.0338413.ref006","doi-asserted-by":"crossref","first-page":"4688","DOI":"10.12998\/wjcc.v8.i20.4688","article-title":"Relationship between non-alcoholic fatty liver disease and coronary heart disease","volume":"8","author":"U Arslan","year":"2020","journal-title":"World J Clin Cases"},{"issue":"7","key":"pone.0338413.ref007","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00392-020-01709-7","article-title":"NAFLD and cardiovascular diseases: a clinical review","volume":"110","author":"P Kasper","year":"2021","journal-title":"Clin Res Cardiol"},{"issue":"2","key":"pone.0338413.ref008","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.aohep.2019.07.013","article-title":"Chronic kidney disease in patients with non-alcoholic fatty liver disease: What the Hepatologist should know?","volume":"19","author":"S Kiapidou","year":"2020","journal-title":"Ann Hepatol"},{"issue":"26","key":"pone.0338413.ref009","doi-asserted-by":"crossref","first-page":"8351","DOI":"10.3748\/wjg.v20.i26.8351","article-title":"Nonalcoholic fatty liver disease and polycystic ovary syndrome","volume":"20","author":"E Vassilatou","year":"2014","journal-title":"World J Gastroenterol"},{"issue":"5","key":"pone.0338413.ref010","doi-asserted-by":"crossref","first-page":"641","DOI":"10.4254\/wjh.v15.i5.641","article-title":"Hypothyroidism and non-alcoholic fatty liver disease: A coincidence or a causal relationship?","volume":"15","author":"B Janota","year":"2023","journal-title":"World J Hepatol"},{"key":"pone.0338413.ref011","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s12325-019-01080-8","article-title":"Hypothyroidism in context: where we\u2019ve been and where we\u2019re going","volume":"36","author":"L Chiovato","year":"2019","journal-title":"Adv Ther"},{"issue":"11","key":"pone.0338413.ref012","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.eprac.2023.08.006","article-title":"Prevalence and trends of thyroid disease among adults, 1999-2018","volume":"29","author":"X Zhang","year":"2023","journal-title":"Endocrine Practice"},{"issue":"23","key":"pone.0338413.ref013","doi-asserted-by":"crossref","DOI":"10.3390\/ijms222312797","article-title":"Hypothyroidism-associated dyslipidemia: potential molecular mechanisms leading to NAFLD","volume":"22","author":"M Mavromati","year":"2021","journal-title":"Int J Mol Sci"},{"issue":"1","key":"pone.0338413.ref014","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41572-022-00357-7","article-title":"Hypothyroidism","volume":"8","author":"L Chaker","year":"2022","journal-title":"Nature Reviews Disease Primers"},{"issue":"1","key":"pone.0338413.ref015","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1080\/13696998.2021.1900202","article-title":"The direct and indirect economic burden of hypothyroidism in the United States: a retrospective claims database study","volume":"24","author":"Z Hepp","year":"2021","journal-title":"J Med Econ"},{"key":"pone.0338413.ref016","doi-asserted-by":"crossref","first-page":"106658","DOI":"10.1016\/j.nbd.2024.106658","article-title":"The role of thyroid-stimulating hormone in regulating lipid metabolism: implications for body-brain communication","volume":"201","author":"X Wang","year":"2024","journal-title":"Neurobiol Dis"},{"issue":"2","key":"pone.0338413.ref017","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1152\/physrev.00030.2013","article-title":"Thyroid hormone regulation of metabolism","volume":"94","author":"R Mullur","year":"2014","journal-title":"Physiol Rev"},{"issue":"8","key":"pone.0338413.ref018","article-title":"Nonalcoholic fatty liver disease and hypothyroidism: what you need to know","volume":"14","author":"V Bikeyeva","year":"2022","journal-title":"Cureus"},{"issue":"17","key":"pone.0338413.ref019","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000025738","article-title":"The relationship between non-alcoholic fatty liver disease and hypothyroidism: A systematic review and meta-analysis","volume":"100","author":"X Zeng","year":"2021","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"pone.0338413.ref020","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s12902-022-01050-2","article-title":"Correlation between the thyroid hormone levels and nonalcoholic fatty liver disease in type 2 diabetic patients with normal thyroid function","volume":"22","author":"Y Zhang","year":"2022","journal-title":"BMC Endocr Disord"},{"issue":"3","key":"pone.0338413.ref021","doi-asserted-by":"crossref","first-page":"347","DOI":"10.14218\/JCTH.2020.00027","article-title":"Hypothyroidism and nonalcoholic fatty liver disease: pathophysiological associations and therapeutic implications","volume":"8","author":"T Kizivat","year":"2020","journal-title":"J Clin Transl Hepatol"},{"issue":"10","key":"pone.0338413.ref022","article-title":"Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions","volume":"2019","author":"M Cumpston","year":"2019","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"1","key":"pone.0338413.ref023","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"10","author":"MJ Page","year":"2021","journal-title":"Syst Rev"},{"issue":"1","key":"pone.0338413.ref024","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2165\/11598070-000000000-00000","article-title":"Overt and subclinical hypothyroidism: who to treat and how","volume":"72","author":"D Khandelwal","year":"2012","journal-title":"Drugs"},{"key":"pone.0338413.ref025","article-title":"Non-alcoholic fatty liver disease: definition and subtypes","volume":"29","author":"SK Han","year":"2023","journal-title":"Clin Mol Hepatol"},{"key":"pone.0338413.ref026","author":"Joanna Briggs Institute","year":"2023"},{"issue":"7","key":"pone.0338413.ref027","article-title":"Impact of thyroid function on the prevalence and mortality of metabolic dysfunction-associated fatty liver disease","volume":"108","author":"Y-L Chen","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"pone.0338413.ref028","article-title":"Subclinical hypothyroidism and low-normal thyroid function are associated with nonalcoholic steatohepatitis and fibrosis","volume":"16","author":"D Kim","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"9","key":"pone.0338413.ref029","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.14309\/ajg.0000000000000654","article-title":"Low thyroid function in nonalcoholic fatty liver disease is an independent predictor of all-cause and cardiovascular mortality","volume":"115","author":"D Kim","year":"2020","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"pone.0338413.ref030","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/00004836-200310000-00014","article-title":"Is hypothyroidism a risk factor for non-alcoholic steatohepatitis?","volume":"37","author":"S Liangpunsakul","year":"2003","journal-title":"J Clin Gastroenterol"},{"issue":"2","key":"pone.0338413.ref031","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1007\/s10620-011-2006-2","article-title":"Prevalence of hypothyroidism in nonalcoholic fatty liver disease","volume":"57","author":"MR Pagadala","year":"2012","journal-title":"Dig Dis Sci"},{"issue":"6","key":"pone.0338413.ref032","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1111\/jgh.16163","article-title":"Non-alcoholic steatohepatitis is independently associated with a history of gestational diabetes mellitus","volume":"38","author":"A Boustany","year":"2023","journal-title":"J Gastroenterol Hepatol"},{"issue":"1","key":"pone.0338413.ref033","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/ijpo.12110","article-title":"Thyroid dysfunction and hepatic steatosis in overweight children and adolescents","volume":"12","author":"TE-M Kaltenbach","year":"2017","journal-title":"Pediatr Obes"},{"issue":"7","key":"pone.0338413.ref034","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1002\/ueg2.12124","article-title":"Impact of thyroid disorders on the incidence of non-alcoholic fatty liver disease in Germany","volume":"9","author":"C Labenz","year":"2021","journal-title":"United European Gastroenterol J"},{"key":"pone.0338413.ref035","doi-asserted-by":"crossref","DOI":"10.1097\/MEG.0000000000002136","article-title":"Incidences of hypothyroidism and autoimmune thyroiditis are increased in patients with nonalcoholic fatty liver disease","volume":"33","author":"SH Loosen","year":"2021","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"pone.0338413.ref036","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12902-015-0030-5","article-title":"Subclinical and clinical hypothyroidism and non-alcoholic fatty liver disease: a cross-sectional study of a random population sample aged 18 to 65 years","volume":"15","author":"U Ludwig","year":"2015","journal-title":"BMC Endocr Disord"},{"issue":"12","key":"pone.0338413.ref037","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1111\/jgh.12998","article-title":"Thyroid function is associated with non-alcoholic fatty liver disease in chronic hepatitis B-infected subjects","volume":"30","author":"W-J Ding","year":"2015","journal-title":"J Gastroenterol Hepatol"},{"issue":"1","key":"pone.0338413.ref038","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s12876-022-02612-3","article-title":"Low thyroid function is associated with an increased risk of advanced fibrosis in patients with metabolic dysfunction-associated fatty liver disease","volume":"23","author":"H Fan","year":"2023","journal-title":"BMC Gastroenterol"},{"issue":"2","key":"pone.0338413.ref039","doi-asserted-by":"crossref","DOI":"10.1002\/jgh3.13038","article-title":"Low thyroid function is associated with metabolic dysfunction-associated steatotic liver disease","volume":"8","author":"S Wang","year":"2024","journal-title":"JGH Open"},{"issue":"26","key":"pone.0338413.ref040","article-title":"Relationship between thyroid hormone levels and metabolic dysfunction associated steatotic liver disease in patients with type 2 diabetes: a clinical study","volume":"103","author":"T Bi","year":"2024","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"pone.0338413.ref041","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s12902-024-01618-0","article-title":"Associations of sex-related and thyroid-related hormones with risk of metabolic dysfunction-associated fatty liver disease in T2DM patients","volume":"24","author":"W Lu","year":"2024","journal-title":"BMC Endocr Disord"},{"issue":"4","key":"pone.0338413.ref042","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.jceh.2023.03.004","article-title":"The interrelation between hypothyroidism and non-alcoholic fatty liver disease, a cross-sectional study","volume":"13","author":"S Elshinshawy","year":"2023","journal-title":"J Clin Exp Hepatol"},{"issue":"3","key":"pone.0338413.ref043","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4103\/ejim.ejim_3_18","article-title":"Thyroid dysfunction and insulin resistance in patients with nonalcoholic fatty liver disease","volume":"30","author":"MA Hussein","year":"2018","journal-title":"Egypt J Intern Med"},{"issue":"7","key":"pone.0338413.ref044","doi-asserted-by":"crossref","first-page":"94","DOI":"10.22192\/ijcrms.2017.03.07.016","article-title":"Association and impact of non-alcoholic fatty liver disease on thyroid function","volume":"3","author":"A Kassem","year":"2017","journal-title":"Int J Curr Res Med Sci"},{"issue":"2","key":"pone.0338413.ref045","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1177\/0049475520945058","article-title":"Non-alcoholic fatty liver disease in patients with hypothyroidism presenting at a rural tertiary care centre in north India","volume":"51","author":"H Grewal","year":"2021","journal-title":"Trop Doct"},{"issue":"2","key":"pone.0338413.ref046","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s12664-015-0541-z","article-title":"Prevalence of hypothyroidism in nonalcoholic fatty liver disease in patients attending a tertiary hospital in western India","volume":"34","author":"P Parikh","year":"2015","journal-title":"Indian J Gastroenterol"},{"issue":"3","key":"pone.0338413.ref047","doi-asserted-by":"crossref","first-page":"145","DOI":"10.4103\/injms.injms_24_23","article-title":"Prevalence of nonalcoholic fatty liver disease in hypothyroid subjects: a cross-sectional comparative study","volume":"14","author":"M Patel","year":"2023","journal-title":"Indian J Med Special"},{"issue":"9","key":"pone.0338413.ref048","article-title":"A study of non-alcoholic fatty liver disease in patients with hypothyroidism: a cross-sectional study in a tertiary care hospital","volume":"16","author":"ML Mahashabde","year":"2024","journal-title":"Cureus"},{"issue":"10","key":"pone.0338413.ref049","first-page":"584","article-title":"Nonalcoholic fatty liver disease in a cluster of Iranian population: thyroid status and metabolic risk factors","volume":"16","author":"A Eshraghian","year":"2013","journal-title":"Arch Iran Med"},{"key":"pone.0338413.ref050","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4103\/abr.abr_15_21","article-title":"Association of subclinical hypothyroidism with nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a cross-sectional study","volume":"11","author":"V Sheikhi","year":"2022","journal-title":"Adv Biomed Res"},{"issue":"1","key":"pone.0338413.ref051","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jhep.2012.02.027","article-title":"Non-alcoholic fatty liver disease across the spectrum of hypothyroidism","volume":"57","author":"GE Chung","year":"2012","journal-title":"J Hepatol"},{"issue":"4","key":"pone.0338413.ref052","doi-asserted-by":"crossref","first-page":"372","DOI":"10.3350\/cmh.2015.21.4.372","article-title":"Impact of hypothyroidism on the development of non-alcoholic fatty liver disease: a 4-year retrospective cohort study","volume":"21","author":"KW Lee","year":"2015","journal-title":"Clin Mol Hepatol"},{"key":"pone.0338413.ref053","article-title":"Triiodothyronine is associated with incidence\/resolution of steatotic liver disease: longitudinal study in euthyroid Korean","author":"HI Kim","year":"2024","journal-title":"Endocrinol Metab (Seoul)"},{"issue":"2","key":"pone.0338413.ref054","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3720","article-title":"Hypothyroidism and subclinical hypothyroidism are associated with fatty pancreas (Non-Alcoholic Fatty Pancreas Disease)","volume":"40","author":"A Bayyigit","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"issue":"4","key":"pone.0338413.ref055","doi-asserted-by":"crossref","first-page":"221","DOI":"10.6061\/clinics\/2016(04)08","article-title":"FT3\/FT4 ratio predicts non-alcoholic fatty liver disease independent of metabolic parameters in patients with euthyroidism and hypothyroidism","volume":"71","author":"FY G\u00f6kmen","year":"2016","journal-title":"Clinics (Sao Paulo)"},{"issue":"3","key":"pone.0338413.ref056","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1002\/jgh3.12264","article-title":"Thyroid-stimulating hormone is an independent risk factor of non-alcoholic fatty liver disease","volume":"4","author":"K Tahara","year":"2019","journal-title":"JGH Open"},{"issue":"3","key":"pone.0338413.ref057","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1530\/EJE-14-0150","article-title":"Fatty liver largely explains associations of subclinical hypothyroidism with insulin resistance, metabolic syndrome, and subclinical coronary atherosclerosis","volume":"171","author":"C Posadas-Romero","year":"2014","journal-title":"Eur J Endocrinol"},{"issue":"9","key":"pone.0338413.ref058","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1007\/s40618-023-02041-3","article-title":"Association between non-alcoholic fatty liver disease and subclinical hypothyroidism in children with obesity","volume":"46","author":"A Di Sessa","year":"2023","journal-title":"J Endocrinol Invest"},{"issue":"8","key":"pone.0338413.ref059","doi-asserted-by":"crossref","first-page":"3204","DOI":"10.1210\/jc.2016-1300","article-title":"Thyroid function and the risk of nonalcoholic fatty liver disease: the rotterdam study","volume":"101","author":"A Bano","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"pone.0338413.ref060","doi-asserted-by":"crossref","first-page":"139","DOI":"10.38173\/RST.2020.20.2.13:139-146","article-title":"Hypothyroidism-a risk factor for the non-alcoholic fatty liver disease","volume":"20","author":"M Popescu","year":"2020","journal-title":"RST"},{"issue":"3","key":"pone.0338413.ref061","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1111\/liv.15847","article-title":"Thyroid function, adipokines and mitokines in metabolic dysfunction-associated steatohepatitis: a multi-centre biopsy-based observational study","volume":"44","author":"M Kouvari","year":"2024","journal-title":"Liver Int"},{"issue":"4","key":"pone.0338413.ref062","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/00004836-200310000-00014","article-title":"Is hypothyroidism a risk factor for non-alcoholic steatohepatitis?","volume":"37","author":"S Liangpunsakul","year":"2003","journal-title":"J Clin Gastroenterol"},{"issue":"5","key":"pone.0338413.ref063","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.jhep.2012.05.025","article-title":"Impact of subclinical hypothyroidism on the development of non-alcoholic fatty liver disease: a prospective case-control study","volume":"57","author":"L Xu","year":"2012","journal-title":"J Hepatol"},{"issue":"10","key":"pone.0338413.ref064","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1089\/thy.2018.0257","article-title":"Association between primary hypothyroidism and nonalcoholic fatty liver disease: a systematic review and meta-analysis","volume":"28","author":"A Mantovani","year":"2018","journal-title":"Thyroid"},{"issue":"8","key":"pone.0338413.ref065","doi-asserted-by":"crossref","first-page":"3204","DOI":"10.1210\/jc.2016-1300","article-title":"Thyroid function and the risk of nonalcoholic fatty liver disease: the rotterdam study","volume":"101","author":"A Bano","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"pone.0338413.ref066","first-page":"1","article-title":"Prevalence of elevated TSH and its association with dyslipidemia and NAFLD among Filipino adult executive check-up patients in a tertiary hospital","volume":"55","author":"RC Lingad-Sayas","year":"2017","journal-title":"Philippine J Inter Med"},{"key":"pone.0338413.ref067","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12902-015-0030-5","article-title":"Subclinical and clinical hypothyroidism and non-alcoholic fatty liver disease: a cross-sectional study of a random population sample aged 18 to 65 years","volume":"15","author":"U Ludwig","year":"2015","journal-title":"BMC Endocrine Disorders"},{"issue":"4","key":"pone.0338413.ref068","doi-asserted-by":"crossref","first-page":"372","DOI":"10.3350\/cmh.2015.21.4.372","article-title":"Impact of hypothyroidism on the development of non-alcoholic fatty liver disease: a 4-year retrospective cohort study","volume":"21","author":"KW Lee","year":"2015","journal-title":"Clin Mol Hepatol"},{"issue":"7","key":"pone.0338413.ref069","first-page":"488","article-title":"Metabolic syndrome prevalence in subclinic and overt hypothyroid patients and the relation among metabolic syndrome parameters","volume":"34","author":"M Erdogan","year":"2011","journal-title":"J Endocrinol Invest"},{"issue":"4","key":"pone.0338413.ref070","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1136\/gutjnl-2023-330596","article-title":"Thyroid hormone receptor-beta agonists: new MASLD therapies on the horizon","volume":"73","author":"CD Byrne","year":"2024","journal-title":"Gut"},{"issue":"6","key":"pone.0338413.ref071","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1056\/NEJMe2314365","article-title":"Selective agonists of thyroid hormone receptor beta for the treatment of NASH","volume":"390","author":"K Cusi","year":"2024","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0338413.ref072","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.dld.2018.12.014","article-title":"Pathogenesis of hypothyroidism-induced NAFLD: evidence for a distinct disease entity?","volume":"51","author":"A Lonardo","year":"2019","journal-title":"Dig Liver Dis"},{"issue":"4","key":"pone.0338413.ref073","first-page":"288","article-title":"The effect of hypothyroidism occurring in patients with metabolic syndrome","volume":"66","author":"M Gierach","year":"2015","journal-title":"Endokrynol Pol"},{"issue":"6","key":"pone.0338413.ref074","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1089\/thy.2011.0279","article-title":"Inverse association between serum free thyroxine levels and hepatic steatosis: results from the Study of Health in Pomerania","volume":"22","author":"T Ittermann","year":"2012","journal-title":"Thyroid"},{"issue":"1","key":"pone.0338413.ref075","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jhep.2012.02.027","article-title":"Non-alcoholic fatty liver disease across the spectrum of hypothyroidism","volume":"57","author":"GE Chung","year":"2012","journal-title":"J Hepatol"},{"issue":"4","key":"pone.0338413.ref076","doi-asserted-by":"crossref","first-page":"188","DOI":"10.3109\/07435800.2014.987399","article-title":"Free triiodothyronine levels are positively associated with non-alcoholic fatty liver disease in euthyroid middle-aged subjects","volume":"40","author":"G Liu","year":"2015","journal-title":"Endocr Res"},{"issue":"4","key":"pone.0338413.ref077","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1530\/EJE-11-0907","article-title":"Diagnosis of subclinical central hypothyroidism in patients with hypothalamic-pituitary disease by Doppler echocardiography","volume":"166","author":"FC Doin","year":"2012","journal-title":"Eur J Endocrinol"},{"key":"pone.0338413.ref078","doi-asserted-by":"crossref","first-page":"289503","DOI":"10.1155\/2014\/289503","article-title":"Serum thyrotropin is positively correlated with the metabolic syndrome components of obesity and dyslipidemia in chinese adolescents","volume":"2014","author":"J Zhang","year":"2014","journal-title":"Int J Endocrinol"},{"issue":"11","key":"pone.0338413.ref079","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1089\/thy.2012.0013","article-title":"Age and gender substantially influence the relationship between thyroid status and the lipoprotein profile: results from a large cross-sectional study","volume":"22","author":"S Tognini","year":"2012","journal-title":"Thyroid"},{"issue":"2","key":"pone.0338413.ref080","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.hbpd.2022.01.006","article-title":"Prevalence and characteristics of MAFLD in Chinese adults aged 40 years or older: a community-based study","volume":"21","author":"J Zeng","year":"2022","journal-title":"Hepatobiliary Pancreat Dis Int"},{"issue":"39","key":"pone.0338413.ref081","doi-asserted-by":"crossref","first-page":"14185","DOI":"10.3748\/wjg.v20.i39.14185","article-title":"Nonalcoholic fatty liver disease and aging: epidemiology to management","volume":"20","author":"M Bertolotti","year":"2014","journal-title":"World J Gastroenterol"},{"issue":"8","key":"pone.0338413.ref082","doi-asserted-by":"crossref","first-page":"718","DOI":"10.3390\/metabo12080718","article-title":"Insight into Potential Interactions of Thyroid Hormones, Sex Hormones and Their Stimulating Hormones in the Development of Non-Alcoholic Fatty Liver Disease","volume":"12","author":"E Fr\u00f6hlich","year":"2022","journal-title":"Metabolites"},{"issue":"17","key":"pone.0338413.ref083","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000025738","article-title":"The relationship between non-alcoholic fatty liver disease and hypothyroidism: a systematic review and meta-analysis","volume":"100","author":"X Zeng","year":"2021","journal-title":"Medicine (Baltimore)"},{"key":"pone.0338413.ref084","doi-asserted-by":"crossref","first-page":"5083746","DOI":"10.1155\/2016\/5083746","article-title":"Histopathologic evaluation of nonalcoholic fatty liver disease in hypothyroidism-induced rats","volume":"2016","author":"\u015e Demir","year":"2016","journal-title":"Int J Endocrinol"},{"issue":"1","key":"pone.0338413.ref085","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s11596-012-0008-8","article-title":"Relationship between serum TSH level with obesity and NAFLD in euthyroid subjects","volume":"32","author":"J Zhang","year":"2012","journal-title":"J Huazhong Univ Sci Technolog Med Sci"},{"key":"pone.0338413.ref086","doi-asserted-by":"crossref","first-page":"1407996","DOI":"10.3389\/fendo.2024.1407996","article-title":"Association between hypothyroidism and metabolic syndrome in Qinghai, China","volume":"15","author":"X Fan","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0338413.ref087","doi-asserted-by":"crossref","first-page":"1106968","DOI":"10.3389\/fendo.2023.1106968","article-title":"Subclinical hypothyroidism increases insulin resistance in normoglycemic people","volume":"14","author":"W Yang","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0338413.ref088","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2018.00511","article-title":"A renewed focus on the association between thyroid hormones and lipid metabolism","volume":"9","author":"LH Duntas","year":"2018","journal-title":"Front Endocrinol"},{"issue":"4","key":"pone.0338413.ref089","doi-asserted-by":"crossref","first-page":"44","DOI":"10.21304\/2017.0404.00213","article-title":"Sick euthyroid syndrome: a myth or reality","volume":"4","author":"V Patki","year":"2017","journal-title":"J Pediatr Crit Care"},{"issue":"2","key":"pone.0338413.ref090","first-page":"339","article-title":"The concentration of interleukin 6 and tumor necrosis factor alpha in saliva and blood of patients with inactive multiple sclerosis and coexisting hashimoto\u2019s thyroiditis","volume":"62","author":"I \u0160i\u0161ko Marko\u0161","year":"2023","journal-title":"Acta Clin Croat"},{"key":"pone.0338413.ref091","doi-asserted-by":"crossref","first-page":"880298","DOI":"10.3389\/fimmu.2022.880298","article-title":"Association of inflammatory cytokines with non-alcoholic fatty liver disease","volume":"13","author":"Y Duan","year":"2022","journal-title":"Front Immunol"},{"key":"pone.0338413.ref092","doi-asserted-by":"crossref","first-page":"101266","DOI":"10.1016\/j.molmet.2021.101266","article-title":"Early induction of hepatic deiodinase type 1 inhibits hepatosteatosis during NAFLD progression","volume":"53","author":"E Bruinstroop","year":"2021","journal-title":"Mol Metab"},{"issue":"6","key":"pone.0338413.ref093","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.3390\/biomedicines10061232","article-title":"Effects of thyroid hormones on lipid metabolism pathologies in non-alcoholic fatty liver disease","volume":"10","author":"C-J Liao","year":"2022","journal-title":"Biomedicines"},{"issue":"12","key":"pone.0338413.ref094","doi-asserted-by":"crossref","first-page":"2412","DOI":"10.1111\/bph.15427","article-title":"Activation of thyroid hormone receptor-\u03b2 improved disease activity and metabolism independent of body weight in a mouse model of non-alcoholic steatohepatitis and fibrosis","volume":"178","author":"A Kannt","year":"2021","journal-title":"Br J Pharmacol"},{"issue":"709","key":"pone.0338413.ref095","doi-asserted-by":"crossref","DOI":"10.1126\/scisignal.abh3839","article-title":"Thyroid hormone signaling promotes hepatic lipogenesis through the transcription factor ChREBP","volume":"14","author":"A Mendoza","year":"2021","journal-title":"Sci Signal"},{"issue":"7","key":"pone.0338413.ref096","doi-asserted-by":"crossref","first-page":"2428","DOI":"10.1172\/JCI60580","article-title":"Thyroid hormone stimulates hepatic lipid catabolism via activation of autophagy","volume":"122","author":"RA Sinha","year":"2012","journal-title":"J Clin Invest"},{"key":"pone.0338413.ref097","doi-asserted-by":"crossref","first-page":"335","DOI":"10.3389\/fendo.2017.00335","article-title":"Relationship between hypothyroidism and non-alcoholic fatty liver disease: a systematic review and meta-analysis","volume":"8","author":"W He","year":"2017","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0338413.ref098","doi-asserted-by":"crossref","first-page":"1399517","DOI":"10.3389\/fendo.2024.1399517","article-title":"Association between thyroid function and nonalcoholic fatty liver disease: a dose-response meta-analysis","volume":"15","author":"L-L Xiang","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"23","key":"pone.0338413.ref099","doi-asserted-by":"crossref","first-page":"7392","DOI":"10.3748\/wjg.v20.i23.7392","article-title":"Radiologic evaluation of nonalcoholic fatty liver disease","volume":"20","author":"SS Lee","year":"2014","journal-title":"World J Gastroenterol"},{"issue":"23","key":"pone.0338413.ref100","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1001\/jama.2020.22196","article-title":"Autoimmune thyroid disease in women","volume":"325","author":"JSR Mammen","year":"2021","journal-title":"JAMA"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338413","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T18:34:23Z","timestamp":1766082863000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338413"}},"subtitle":[],"editor":[{"given":"Afagh Hassanzadeh","family":"Rad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":100,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0338413","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,18]]}}}