Prevalence and Determinants of Non-Alcoholic Fatty Liver Disease among Patients with Hypothyroidism: A Cross-Sectional Study from a Tertiary Care Center

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver disorders worldwide and is increasingly recognized as a major metabolic health concern. Hypothyroidism has been implicated in the development of hepatic steatosis through mechanisms involving insulin resistance, dyslipidemia, impaired lipid metabolism, and reduced energy expenditure. However, data regarding the burden of NAFLD among hypothyroid patients and the factors influencing its occurrence remain limited in the Indian population. Methods: A hospital-based cross-sectional observational study was conducted among 200 adult patients diagnosed with hypothyroidism attending a tertiary care teaching hospital in Southern India between July 2024 and July 2025. Demographic characteristics, duration of hypothyroidism, treatment history, anthropometric measurements, biochemical parameters, and comorbid conditions were recorded. Thyroid function tests and routine biochemical investigations were performed using standard laboratory methods. Abdominal ultrasonography was used to diagnose NAFLD after excluding secondary causes of hepatic steatosis. Statistical analysis was performed using SPSS version 25.0. Associations between variables were assessed using the Chi-square test and multivariable logistic regression analysis. Results: Among the 200 hypothyroid patients included in the study, females constituted 64.0% of the study population and the majority belonged to the 31–45-year age group (32.0%). NAFLD was detected in 80 participants, yielding a prevalence of 40.0%. Elevated TSH levels were observed in 75.0% of patients with NAFLD compared with 50.0% among those without NAFLD (p<0.001). Low FT4 levels were also significantly associated with hepatic steatosis (p=0.002). Obesity was present in 52.5% of NAFLD patients and demonstrated a strong association with disease occurrence (p<0.001). Diabetes mellitus, longer duration of hypothyroidism, and irregular treatment compliance were significantly more common among patients with NAFLD. Multivariable logistic regression identified obesity (AOR 3.12), elevated TSH (AOR 2.85), irregular treatment compliance (AOR 2.61), diabetes mellitus (AOR 2.23), and hypothyroidism duration exceeding five years (AOR 1.94) as independent predictors of NAFLD. Conclusion: NAFLD was highly prevalent among patients with hypothyroidism and showed significant associations with thyroid dysfunction, obesity, diabetes mellitus, prolonged disease duration, and poor treatment adherence. Routine screening for NAFLD among hypothyroid patients, particularly those with additional metabolic risk factors, may facilitate early diagnosis and timely intervention, thereby reducing future hepatic and metabolic complications.