Highlights
- End-stage MASH cirrhosis demonstrates markedly reduced hepatic and systemic T3 and T4 with elevated systemic reverse T3 (rT3), indicating impaired hepatic deiodinase activity and intrahepatic hypothyroidism.
- The hepatic T3 concentration and systemic T3/rT3 ratio robustly discriminate MASH from healthy liver, highlighting their complementary diagnostic value as functional biomarkers of thyroid hormone metabolism in MASH.
- Within established cirrhosis, systemic total T4 correlates inversely with established severity scores (MELD and Child-Pugh), positioning T4 as a potent biomarker for disease progression and prognosis.
- Therapeutic advances such as resmetirom, a selective thyroid hormone receptor β agonist, demonstrate antifibrotic efficacy in non-cirrhotic MASH; however, levothyroxine use in MASH shows no clear benefit in cirrhosis progression, suggesting the importance of selective TH modulation.
Specialty calculators
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