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The metabolic vulnerability index (MVX) derives from blood-based inflammation (IVX) and malnutrition (MMX) markers measured by nuclear magnetic resonance (NMR) spectroscopy. We aimed to explore the association of subclinical hypothyroidism and thyroid-related parameters with IVX, MMX, and MVX scores. Methods: This cross-sectional study used the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Individuals with normal thyroid function and subclinical hypothyroidism were included. Thyroid-related parameters\u2014thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), the FT3\u2013FT4 ratio, and antithyroperoxidase antibodies (TPOAb)\u2014were the explanatory variables. The primary outcomes, MVX, MMX, and IVX scores, were analyzed as continuous variables. Linear regression analyses were performed for both univariate and multivariable models, with sensitivity and subgroup analyses applied to assess robustness. Findings: There were 3979 participants (51.4% female) with a mean age of 51.26 (SD: 9.02) years. After full adjustment for potential confounder variables, FT3 levels [B: \u22121.37 (\u22122.43;\u22120.31) p = 0.011] and the FT3\u2013FT4 ratio [B: \u22120.90 (\u22121.79;\u22120.01) p = 0.047] were inversely associated with MVX scores. FT3 levels were also inversely associated with IVX [B: \u22121.32 (\u22122.39;\u22120.24) p = 0.017]. These results were consistent in euthyroid individuals and those with cardiometabolic diseases. In the sex-stratified analysis, FT3 levels were inversely associated with MVX, MMX, and IVX scores for men. Conclusion: Lower FT3 levels and the FT3\u2013FT4 ratio were associated with a higher metabolic vulnerability in our cohort. Our study sheds light on the importance of metabolic surveillance in these patients, especially for men with cardiometabolic diseases.<\/jats:p>","DOI":"10.3390\/metabo15090606","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T14:23:50Z","timestamp":1757600630000},"page":"606","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Metabolic Vulnerability Index (MVX) in Subclinical Thyroid Disorders and Euthyroidism: A Cross-Sectional Exploratory Analysis from the ELSA-Brasil Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9383-7907","authenticated-orcid":false,"given":"Carolina Castro Porto Silva","family":"Janovsky","sequence":"first","affiliation":[{"name":"Center for Clinical and Epidemiological Research, Universidade de Sao Paulo (USP), S\u00e3o Paulo 05508-000, SP, Brazil"},{"name":"Division of Endocrinology, Escola Paulista de Medicina\/Universidade Federal de S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo 04022-001, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vandrize","family":"Meneghini","sequence":"additional","affiliation":[{"name":"Center for Clinical and Epidemiological Research, Universidade de Sao Paulo (USP), S\u00e3o Paulo 05508-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Tebar","sequence":"additional","affiliation":[{"name":"Center for Clinical and Epidemiological Research, Universidade de Sao Paulo (USP), S\u00e3o Paulo 05508-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao Roberto Maciel","family":"Martins","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Escola Paulista de Medicina\/Universidade Federal de S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo 04022-001, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7187-984X","authenticated-orcid":false,"given":"Jos\u00e9 Augusto","family":"Sgarbi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Faculdade de Medicina de Mar\u00edlia, Mar\u00edlia 17519-030, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patr\u00edcia de Fatima dos Santos","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Medicine School, Federal University of Rio de Janeiro, Rio de Janeiro 21044-020, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itamar de Souza","family":"Santos","sequence":"additional","affiliation":[{"name":"Center for Clinical and Epidemiological Research, Universidade de Sao Paulo (USP), S\u00e3o Paulo 05508-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Jones","sequence":"additional","affiliation":[{"name":"Johns Hopkins, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Blaha","sequence":"additional","affiliation":[{"name":"Johns Hopkins, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5810-5460","authenticated-orcid":false,"given":"Peter P.","family":"Toth","sequence":"additional","affiliation":[{"name":"Johns Hopkins, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA"},{"name":"CGH Medical Center, Department of Preventive Cardiology, Sterling, IL 61081, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcio S.","family":"Bittencourt","sequence":"additional","affiliation":[{"name":"Department of Medicine and Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15261, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9860-6582","authenticated-orcid":false,"given":"Raul D.","family":"Santos","sequence":"additional","affiliation":[{"name":"Heart Institute (InCor), University of S\u00e3o Paulo Medical School Hospital, S\u00e3o Paulo 05403-900, SP, Brazil"},{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo A.","family":"Lotufo","sequence":"additional","affiliation":[{"name":"Center for Clinical and Epidemiological Research, Universidade de Sao Paulo (USP), S\u00e3o Paulo 05508-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Layal","family":"Chaker","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The 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