Impact of thyroid dysfunction and diabetes on fibrosis and steatosis stages in metabolic dysfunction associated fatty liver disease

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 . 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 ^® ) for those with FIB-4 scores > 3.25. Significant differences were observed in the distribution of body mass index (BMI), liver enzymes, and fibrosis stages across the groups ( P  < 0.001, for all). Group C exhibited the highest prevalence of advanced fibrosis (F2–F3), while severe steatosis (S3) was predominant in Group D. Hypothyroidism and subclinical hypothyroidism were associated with elevated FIB-4 scores and advanced steatosis ( p  = 0.033), 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.