El efecto del hipotiroidismo en el hígado graso no alcohólico

RESUMEN Antecedentes: el efecto de los trastornos funcionales tiroideos en la patogénesis del hígado graso no alcohólico aún no está completamente definido. Las hormonas tiroideas juegan un papel fundamental en el metabolismo lipídico, el hipotiroidismo causa dislipidemia; asimismo, se ha asociado con el síndrome metabólico y, por tanto, podría tener un papel esencial en la patogénesis del hígado graso no alcohólico. Objetivo: conocer la prevalencia de hígado graso no alcohólico en pacientes con hipotiroidismo. Material y método: estudio de casos y controles en el que se revisaron los expedientes de los pacientes del Centro Integral de Diagnóstico y Tratamiento de Médica Sur con valoración médica preventiva durante 2012; los pacientes se categorizaron de acuerdo con su estado de hipotiroidismo. Se realizó ultrasonido de abdomen superior para establecer la existencia de hígado graso y se calculó el grado de fibrosis utilizando el puntaje de fibrosis en enfermedad hepática grasa no alcohólica. Resultados: la esteatosis hepática se asoció con hipotiroidismo independientemente de si éste era subclínico o manifiesto, afectó a 62% de los sujetos con hipotiroidismo vs 52% de los eutiroideos. La asociación de hipotiroidismo con la esteatosis leve fue significativa: 51% de los hipotiroideos vs 31% de los eutiroideos (p=0.0180) e incluso mayor en los infrasustituidos (62%, p = 0.0253). Conclusiones: el hipotiroidismo puede predecir un grado leve de esteatosis, independientemente de otros factores del síndrome metabólico. El estudio sugiere al hipotiroidismo como factor de riesgo independiente de esteatosis hepática. Palabras clave: hígado graso no alcohólico, hipotiroidismo, hipotiroidismo subclínico, esteatosis hepática, dislipidemia.

Palabras clave: hipotiroidismo subclínico, dislipidemia, hipotiroidismo, hígado graso no alcohólico, esteatosis hepática

ABSTRACT Background: The role of thyroid functional disorders in non-alcoholic fatty liver disease has not been completely defined. Thyroid hormones play a fundamental role in the metabolism of lipids. Hypothyroidism causes hypercholesterolemia, and has been associated with metabolic syndrome, for this reason, it could have an essential role in the pathogenesis of non-alcoholic fatty liver disease. Objective: To find the prevalence of non-alcoholic fatty liver disease in patients with hypothyroidism. Material and method: A case-control study was made, in which we reviewed patient’s files who had a medical preventive exam in the Diagnostic and Treatment Integral Center of Medica Sur, Mexico City, during 2012; taking as cases patients with hypothyroidism in its entire spectrum. Upper abdominal ultrasonography was used to establish the presence of fatty liver and the degree of fibrosis was calculated using the non-alcoholic fatty liver disease fibrosis score. Results: Fatty liver disease was associated with hypothyroidism independently of whether it was in a subclinical or manifested form; it was present in a 62% in patients with hypothyroidism vs 52% in those with euthyroidism. The association between hypothyroidism and mild steatosis was significant: 51% of hypothyroid patients vs 31% of euthyroid patients (p=0.0180), and even higher for the under substituted subjects (62%, p= 0.0253). Conclusion: Hypothyroidism can predict a mild degree of steatosis, independently of other components of the metabolic syndrome. The study strongly suggests hypothyroidism as an independent risk factor for liver steatosis since it took place in a healthy population with similar, determinant metabolic components of non-alcoholic fatty liver disease in all groups. Key words: non-alcoholic fatty liver, hypothyroidism, sub-clinic hypothyroidism, liver steatosis, dislipidemia.

Keywords: hypothyroidism, non-alcoholic fatty liver, sub-clinic hypothyroidism, liver steatosis, dislipidemia