{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:40:13Z","timestamp":1789400413975,"version":"build-2803163510"},"reference-count":55,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health\u2014Ricerca Corrente"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: The relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and thyroid hormones has been established, but the direct effects of TSH on the liver, potentially leading to steatosis, and insulin resistance remain unclear. Objective: To investigate the association of TSH levels with MASLD and insulin resistance. Methods: We conducted a cross-sectional study of 8825 euthyroid individuals. Subjects were volunteers or patients referred to the International Center for Nutritional Status Assessment (University of Milan, Italy) undergoing clinical examination and blood drawing for thyroid function tests and liver indices calculation. Liver outcomes were fatty liver index (FLI), hepatic steatosis index (HSI), and FIB-4. All associations were adjusted for fT4 and confounders. Results: We found a positive association of TSH levels with FLI (\u03b2 = 2.76; p &lt; 0.001) and HSI (\u03b2 = 0.58, p &lt; 0.001). This relationship remained significant when stratifying by sex and BMI category, except for HSI in normal weight individuals. No significant association was found between TSH and hepatic fibrosis or insulin resistance. Conclusions: We found a positive association between TSH levels and MASLD in euthyroid individuals independently of fT4, sex, and BMI. Insulin resistance and hepatic fibrosis appear unrelated to TSH, independent of fT4 and BMI. The specific role of TSH in MASLD warrants further investigation.<\/jats:p>","DOI":"10.3390\/jcm14072401","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T11:08:40Z","timestamp":1743505720000},"page":"2401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Thyroid Stimulating Hormone Levels Are Related to Fatty Liver Indices Independently of Free Thyroxine: A Cross-Sectional Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5732-2228","authenticated-orcid":false,"given":"Federica","family":"Sileo","sequence":"first","affiliation":[{"name":"International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milan, Italy"},{"name":"IRCCS Istituto Auxologico Italiano, Clinical Nutrition Unit, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8063-8490","authenticated-orcid":false,"given":"Alessandro","family":"Leone","sequence":"additional","affiliation":[{"name":"International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milan, Italy"},{"name":"IRCCS Istituto Auxologico Italiano, Clinical Nutrition Unit, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0403-5465","authenticated-orcid":false,"given":"Ramona","family":"De Amicis","sequence":"additional","affiliation":[{"name":"International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milan, Italy"},{"name":"IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2803-7713","authenticated-orcid":false,"given":"Andrea","family":"Foppiani","sequence":"additional","affiliation":[{"name":"International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milan, Italy"},{"name":"IRCCS Istituto Auxologico Italiano, Clinical Nutrition Unit, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laila","family":"Vignati","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Auxologico Italiano, Clinical Nutrition Unit, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3781-7148","authenticated-orcid":false,"given":"Francesca","family":"Menichetti","sequence":"additional","affiliation":[{"name":"International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Pozzi","sequence":"additional","affiliation":[{"name":"International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5867-8074","authenticated-orcid":false,"given":"Simona","family":"Bertoli","sequence":"additional","affiliation":[{"name":"International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milan, Italy"},{"name":"IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4134-0557","authenticated-orcid":false,"given":"Alberto","family":"Battezzati","sequence":"additional","affiliation":[{"name":"International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milan, Italy"},{"name":"IRCCS Istituto Auxologico Italiano, Clinical Nutrition Unit, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"ref_1","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":"Lonardo","year":"2019","journal-title":"Dig. Liver Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1016\/j.jhep.2014.12.006","article-title":"Thyroid-stimulating hormone regulates hepatic bile acid homeostasis via SREBP-2\/HNF-4\u03b1\/CYP7A1 axis","volume":"62","author":"Song","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1002\/hep.23800","article-title":"A novel role for thyroid-stimulating hormone: Up-regulation of hepatic 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase expression through the cyclic adenosine monophosphate\/protein kinase A\/cyclic adenosine monophosphate-responsive element binding prote","volume":"52","author":"Tian","year":"2010","journal-title":"Hepatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/j.jhep.2014.06.037","article-title":"Thyrotropin increases hepatic triglyceride content through upregulation of SREBP-1c activity","volume":"61","author":"Yan","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.bbrc.2018.01.187","article-title":"Liver-specific deletion of TSHR inhibits hepatic lipid accumulation in mice","volume":"497","author":"Zhou","year":"2018","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1038\/nrendo.2018.10","article-title":"Direct effects of thyroid hormones on hepatic lipid metabolism","volume":"14","author":"Sinha","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Huang, B., Wen, W., and Ye, S. (2022). TSH-SPP1\/TR\u03b2-TSH positive feedback loop mediates fat deposition of hepatocyte: Crosstalk between thyroid and liver. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.1009912"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"10637","DOI":"10.1007\/s11033-023-08834-2","article-title":"Thyroid-stimulating hormone may participate in insulin resistance by activating toll-like receptor 4 in liver tissues of subclinical hypothyroid rats","volume":"50","author":"Bao","year":"2023","journal-title":"Mol. Biol. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2522","DOI":"10.1210\/clinem\/dgac393","article-title":"Thyroid Stimulating Hormone Levels Are Associated With Genetically Predicted Nonalcoholic Fatty Liver Disease","volume":"107","author":"Fan","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6258","DOI":"10.1038\/s41467-020-20087-2","article-title":"Improving the informativeness of Mendelian disease-derived pathogenicity scores for common disease","volume":"11","author":"Kim","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_11","first-page":"848","article-title":"Longitudinal Change in Thyroid-Stimulating Hormone and Risk of Nonalcoholic Fatty Liver Disease","volume":"19","author":"Chung","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc."},{"key":"ref_12","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":"Chung","year":"2012","journal-title":"J. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1016\/j.jhep.2023.08.030","article-title":"Endocrine aspects of metabolic dysfunction-associated steatotic liver disease (MASLD): Beyond insulin resistance","volume":"79","author":"Hutchison","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1146\/annurev-pathol-020117-043617","article-title":"Recent Insights into the Pathogenesis of Nonalcoholic Fatty Liver Disease","volume":"13","author":"Arab","year":"2018","journal-title":"Annu. Rev. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9330","DOI":"10.3748\/wjg.v20.i28.9330","article-title":"Non-alcoholic fatty liver disease and obesity: Biochemical, metabolic and clinical presentations","volume":"20","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S2468-1253(22)00165-0","article-title":"The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","journal-title":"lancet. Gastroenterol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1056\/NEJM200102153440706","article-title":"Liver biopsy","volume":"344","author":"Bravo","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S123","DOI":"10.3350\/cmh.2022.0357","article-title":"Non-invasive imaging biomarkers for liver steatosis in non-alcoholic fatty liver disease: Present and future","volume":"29","author":"Nogami","year":"2023","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/j.jhep.2015.11.004","article-title":"EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease","volume":"64","author":"Marchesini","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Foschi, F.G., Conti, F., Domenicali, M., Giacomoni, P., Borghi, A., Bevilacqua, V., Napoli, L., Berardinelli, D., Altini, M., and Cucchetti, A. (2021). External Validation of Surrogate Indices of Fatty Liver in the General Population: The Bagnacavallo Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10030520"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1097\/HEP.0000000000000323","article-title":"AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease","volume":"77","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1210\/er.2008-0024","article-title":"The metabolic syndrome","volume":"29","author":"Cornier","year":"2008","journal-title":"Endocr. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S135","DOI":"10.1055\/s-2001-18576","article-title":"Insulin resistance: Definition and consequences","volume":"109","author":"Lebovitz","year":"2001","journal-title":"Exp. Clin. Endocrinol. Diabetes Off. J. Ger. Soc. Endocrinol. Ger. Diabetes Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International","volume":"120","author":"Alberti","year":"2009","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.2337\/diacare.27.6.1487","article-title":"Use and Abuse of HOMA Modeling","volume":"27","author":"Wallace","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1111\/cen.12311","article-title":"Association between thyroid hormones and body fat in euthyroid subjects","volume":"80","author":"Ren","year":"2014","journal-title":"Clin. Endocrinol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1530\/EJE-12-0447","article-title":"Body composition and metabolic parameters are associated with variation in thyroid hormone levels among euthyroid young men","volume":"167","author":"Roef","year":"2012","journal-title":"Eur. J. Endocrinol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1111\/cen.13823","article-title":"Association between thyroid hormone levels, body composition and insulin resistance in euthyroid subjects with normal thyroid ultrasound: The Kangbuk Samsung Health Study","volume":"89","author":"Kwon","year":"2018","journal-title":"Clin. Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.clnu.2014.07.014","article-title":"Relationship between thyroid hormones, resting energy expenditure and cardiometabolic risk factors in euthyroid subjects","volume":"34","author":"Spadafranca","year":"2015","journal-title":"Clin. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1001\/jama.2010.1361","article-title":"Subclinical hypothyroidism and the risk of coronary heart disease and mortality","volume":"304","author":"Rodondi","year":"2010","journal-title":"JAMA"},{"key":"ref_31","unstructured":"Lohman, T.G., Roche, A.F., and Martorell, R. (1988). Anthropometric Standardization Reference Manual, Human Kinetics Books."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1079\/BJN19740060","article-title":"Body fat assessed from total body density and its estimation from skinfold thickness: Measurements on 481 men and women aged from 16 to 72 years","volume":"32","author":"Durnin","year":"1974","journal-title":"Br. J. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A., and Tiribelli, C. (2006). The Fatty Liver Index: A simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol., 6.","DOI":"10.1186\/1471-230X-6-33"},{"key":"ref_34","first-page":"503","article-title":"Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease","volume":"42","author":"Lee","year":"2010","journal-title":"Dig. liver Dis. Off. J. Ital. Soc. Gastroenterol. Ital. Assoc. Study Liver"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection","volume":"43","author":"Sterling","year":"2006","journal-title":"Hepatology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1053\/j.gastro.2021.07.049","article-title":"Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease","volume":"161","author":"Kanwal","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1530\/eje.0.1470733","article-title":"Real-time PCR provides evidence for thyrotropin receptor mRNA expression in orbital as well as in extraorbital tissues","volume":"147","author":"Agretti","year":"2002","journal-title":"Eur. J. Endocrinol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4636","DOI":"10.1111\/j.1582-4934.2008.00670.x","article-title":"Presence of thyrotropin receptor in hepatocytes: Not a case of illegitimate transcription","volume":"13","author":"Zhang","year":"2009","journal-title":"J. Cell. Mol. Med."},{"key":"ref_40","first-page":"1249630","article-title":"Thyroid Stimulating Hormone Triggers Hepatic Mitochondrial Stress through Cyclophilin D Acetylation","volume":"2020","author":"Wang","year":"2020","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ando.2011.03.006","article-title":"Extrathyroidal expression of TSH receptor","volume":"72","author":"Williams","year":"2011","journal-title":"Ann. Endocrinol."},{"key":"ref_42","first-page":"e14858","article-title":"Unraveling the Role of Hypothyroidism in Non-alcoholic Fatty Liver Disease Pathogenesis: Correlations, Conflicts, and the Current Stand","volume":"13","author":"Gor","year":"2021","journal-title":"Cureus"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"He, W., An, X., Li, L., Shao, X., Li, Q., Yao, Q., and Zhang, J.-A. (2017). Relationship between Hypothyroidism and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis. Front. Endocrinol., 8.","DOI":"10.3389\/fendo.2017.00335"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1159\/000454920","article-title":"Nonalcoholic Fatty Liver Disease Is Not Associated with Thyroid Hormone Levels and Hypothyroidism: A Systematic Review and Meta-Analysis","volume":"6","author":"Jaruvongvanich","year":"2017","journal-title":"Eur. Thyroid J."},{"key":"ref_45","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":"Mantovani","year":"2018","journal-title":"Thyroid"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.dld.2018.08.012","article-title":"Association of non-alcoholic fatty liver disease with thyroid function: A systematic review and meta-analysis","volume":"50","author":"Guo","year":"2018","journal-title":"Dig. Liver Dis."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Qiu, S., Cao, P., Guo, Y., Lu, H., and Hu, Y. (2021). Exploring the Causality Between Hypothyroidism and Non-alcoholic Fatty Liver: A Mendelian Randomization Study. Front. Cell Dev. Biol., 9.","DOI":"10.3389\/fcell.2021.643582"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.mce.2017.02.015","article-title":"Thyroid stimulating hormone increases hepatic gluconeogenesis via CRTC2","volume":"446","author":"Li","year":"2017","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_49","first-page":"342","article-title":"Thyroid-Stimulating Hormone Levels Are Positively Associated with Insulin Resistance","volume":"24","author":"Zhu","year":"2018","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/oby.20240","article-title":"High-normal TSH values in obesity: Is it insulin resistance or adipose tissue\u2019s guilt?","volume":"21","author":"Muscogiuri","year":"2013","journal-title":"Obesity"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.maturitas.2009.01.007","article-title":"Thyroid stimulating hormone is associated with metabolic syndrome in euthyroid postmenopausal women","volume":"62","author":"Park","year":"2009","journal-title":"Maturitas"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1210\/jc.2006-1718","article-title":"Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects","volume":"92","author":"Roos","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1089\/thy.2014.0103","article-title":"Serum free thyroxine concentration is associated with metabolic syndrome in euthyroid subjects","volume":"24","author":"Mehran","year":"2014","journal-title":"Thyroid"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"E429","DOI":"10.1152\/ajpendo.00464.2016","article-title":"Insulin resistance and normal thyroid hormone levels: Prospective study and metabolomic analysis","volume":"312","author":"Ferrannini","year":"2017","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1016\/S0140-6736(19)32517-6","article-title":"Resmetirom (MGL-3196) for the treatment of non-alcoholic steatohepatitis: A multicentre, randomised, double-blind, placebo-controlled, phase 2 trial","volume":"394","author":"Harrison","year":"2019","journal-title":"Lancet"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2401\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:07:16Z","timestamp":1760029636000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,31]]},"references-count":55,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14072401"],"URL":"https:\/\/doi.org\/10.3390\/jcm14072401","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,31]]}}}